Carotid stent occlusion after emergent stenting in acute ischemic stroke: Incidence, predictors and clinical relevance

ABSTRACT Background and aims Emergent stent placement may be required during neurothrombectomy. Our aim was to investigate the incidence, predictors and clinical relevance of early extracranial carotid stent occlusion following neurothrombectomy. Methods We retrospectively analyzed a cohort of 761 consecutive neurothrombectomies performed at our center between May 2010 and August 2018, from whom a total of 106 patients had acute internal carotid artery occlusions. Early stent occlusion was defined as complete vessel occlusion within 24h of neurothrombectomy. Clinical outcome was evaluated at day 90 with the modified Rankin Score scale (mRS). Pretreatment, procedural and outcome variables were recorded and analyzed using logistic regression. Results Carotid stenting was performed in 99 (13%) patients. Of those, 22 (22%) had early stent occlusion at follow-up. Stent occlusion was associated with a lower use of post-stenting angioplasty [adjusted OR (aOR)=11.2, 95%CI=2.49-50.78, p=0.002)], increased residual intrastent stenosis (aOR=2.1, 95%CI=1.38-3.06, p 2, aOR=6.3, 95%CI=1.8-22.7, p=0.005), and with an increased rate of symptomatic intracranial hemorrhage at 24 hours (14% versus 1%, p=0.033). Conclusions Early carotid stent occlusion occurred in one out of five neurothrombectomies and was associated with periprocedural factors that included increased residual intrastent stenosis, a lower use of post-stenting angioplasty and unsuccessful intracranial recanalization. Further investigation is warranted for the evaluation of strategies aimed to prevent carotid stent occlusion.