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Research ArticleORIGINAL RESEARCH

Long term stent patency and revascularization rates after emergent carotid stenting during stroke thrombectomy

Alexandru Dimancea, Axelle Y. Kern, Francois Severac, Anca Hasiu, Ian Leonard-Lorant, Roxana Gheoca, Emmanuel Wiener, Véronique Quenardelle, Valérie Wolff, Rémy Beaujeux, Pierre Mangin and Raoul Pop
American Journal of Neuroradiology April 2025, ajnr.A8818; DOI: https://doi.org/10.3174/ajnr.A8818
Alexandru Dimancea
From the Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France (A.D., A.H. I.L.-L., R.B., R.P.); INSERM UMR_S1255, Etablissement Français du Sang, Strasbourg, France (A.Y.K., P.M., R.P.); Public Health Department, Strasbourg University Hospitals, Strasbourg, France (F.S.); Stroke Unit, Strasbourg University Hospitals, Strasbourg, France (R.G., E.W., V.Q., V.W.); and Institut de Chirurgie Minime Invasive Guidée par l’Image, Strasbourg, France (R.B., R.P.).
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Axelle Y. Kern
From the Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France (A.D., A.H. I.L.-L., R.B., R.P.); INSERM UMR_S1255, Etablissement Français du Sang, Strasbourg, France (A.Y.K., P.M., R.P.); Public Health Department, Strasbourg University Hospitals, Strasbourg, France (F.S.); Stroke Unit, Strasbourg University Hospitals, Strasbourg, France (R.G., E.W., V.Q., V.W.); and Institut de Chirurgie Minime Invasive Guidée par l’Image, Strasbourg, France (R.B., R.P.).
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Francois Severac
From the Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France (A.D., A.H. I.L.-L., R.B., R.P.); INSERM UMR_S1255, Etablissement Français du Sang, Strasbourg, France (A.Y.K., P.M., R.P.); Public Health Department, Strasbourg University Hospitals, Strasbourg, France (F.S.); Stroke Unit, Strasbourg University Hospitals, Strasbourg, France (R.G., E.W., V.Q., V.W.); and Institut de Chirurgie Minime Invasive Guidée par l’Image, Strasbourg, France (R.B., R.P.).
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Anca Hasiu
From the Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France (A.D., A.H. I.L.-L., R.B., R.P.); INSERM UMR_S1255, Etablissement Français du Sang, Strasbourg, France (A.Y.K., P.M., R.P.); Public Health Department, Strasbourg University Hospitals, Strasbourg, France (F.S.); Stroke Unit, Strasbourg University Hospitals, Strasbourg, France (R.G., E.W., V.Q., V.W.); and Institut de Chirurgie Minime Invasive Guidée par l’Image, Strasbourg, France (R.B., R.P.).
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Ian Leonard-Lorant
From the Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France (A.D., A.H. I.L.-L., R.B., R.P.); INSERM UMR_S1255, Etablissement Français du Sang, Strasbourg, France (A.Y.K., P.M., R.P.); Public Health Department, Strasbourg University Hospitals, Strasbourg, France (F.S.); Stroke Unit, Strasbourg University Hospitals, Strasbourg, France (R.G., E.W., V.Q., V.W.); and Institut de Chirurgie Minime Invasive Guidée par l’Image, Strasbourg, France (R.B., R.P.).
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Roxana Gheoca
From the Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France (A.D., A.H. I.L.-L., R.B., R.P.); INSERM UMR_S1255, Etablissement Français du Sang, Strasbourg, France (A.Y.K., P.M., R.P.); Public Health Department, Strasbourg University Hospitals, Strasbourg, France (F.S.); Stroke Unit, Strasbourg University Hospitals, Strasbourg, France (R.G., E.W., V.Q., V.W.); and Institut de Chirurgie Minime Invasive Guidée par l’Image, Strasbourg, France (R.B., R.P.).
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Emmanuel Wiener
From the Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France (A.D., A.H. I.L.-L., R.B., R.P.); INSERM UMR_S1255, Etablissement Français du Sang, Strasbourg, France (A.Y.K., P.M., R.P.); Public Health Department, Strasbourg University Hospitals, Strasbourg, France (F.S.); Stroke Unit, Strasbourg University Hospitals, Strasbourg, France (R.G., E.W., V.Q., V.W.); and Institut de Chirurgie Minime Invasive Guidée par l’Image, Strasbourg, France (R.B., R.P.).
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Véronique Quenardelle
From the Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France (A.D., A.H. I.L.-L., R.B., R.P.); INSERM UMR_S1255, Etablissement Français du Sang, Strasbourg, France (A.Y.K., P.M., R.P.); Public Health Department, Strasbourg University Hospitals, Strasbourg, France (F.S.); Stroke Unit, Strasbourg University Hospitals, Strasbourg, France (R.G., E.W., V.Q., V.W.); and Institut de Chirurgie Minime Invasive Guidée par l’Image, Strasbourg, France (R.B., R.P.).
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Valérie Wolff
From the Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France (A.D., A.H. I.L.-L., R.B., R.P.); INSERM UMR_S1255, Etablissement Français du Sang, Strasbourg, France (A.Y.K., P.M., R.P.); Public Health Department, Strasbourg University Hospitals, Strasbourg, France (F.S.); Stroke Unit, Strasbourg University Hospitals, Strasbourg, France (R.G., E.W., V.Q., V.W.); and Institut de Chirurgie Minime Invasive Guidée par l’Image, Strasbourg, France (R.B., R.P.).
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Rémy Beaujeux
From the Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France (A.D., A.H. I.L.-L., R.B., R.P.); INSERM UMR_S1255, Etablissement Français du Sang, Strasbourg, France (A.Y.K., P.M., R.P.); Public Health Department, Strasbourg University Hospitals, Strasbourg, France (F.S.); Stroke Unit, Strasbourg University Hospitals, Strasbourg, France (R.G., E.W., V.Q., V.W.); and Institut de Chirurgie Minime Invasive Guidée par l’Image, Strasbourg, France (R.B., R.P.).
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Pierre Mangin
From the Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France (A.D., A.H. I.L.-L., R.B., R.P.); INSERM UMR_S1255, Etablissement Français du Sang, Strasbourg, France (A.Y.K., P.M., R.P.); Public Health Department, Strasbourg University Hospitals, Strasbourg, France (F.S.); Stroke Unit, Strasbourg University Hospitals, Strasbourg, France (R.G., E.W., V.Q., V.W.); and Institut de Chirurgie Minime Invasive Guidée par l’Image, Strasbourg, France (R.B., R.P.).
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Raoul Pop
From the Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France (A.D., A.H. I.L.-L., R.B., R.P.); INSERM UMR_S1255, Etablissement Français du Sang, Strasbourg, France (A.Y.K., P.M., R.P.); Public Health Department, Strasbourg University Hospitals, Strasbourg, France (F.S.); Stroke Unit, Strasbourg University Hospitals, Strasbourg, France (R.G., E.W., V.Q., V.W.); and Institut de Chirurgie Minime Invasive Guidée par l’Image, Strasbourg, France (R.B., R.P.).
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ABSTRACT

BACKGROUND AND PURPOSE: Emergent carotid artery stenting (eCAS) performed during endovascular treatment (EVT) for acute ischemic stroke (AIS) is associated with increased rates of stent thrombosis. Very limited data is available regarding long-term carotid stent patency or target lesion revascularization (TLR) rates beyond the first 24 hours post EVT.

MATERIALS AND METHODS: We retrospectively analyzed a prospectively maintained stroke EVT database at Strasbourg University Hospitals, including all consecutive patients treated with eCAS during EVT for AIS with tandem lesions (TL) or isolated carotid artery occlusion (ICAO), between November 2009–September 2024.

RESULTS: A total of 220 patients were included in the study, of which 207 TL and 13 ICAO. Stent occlusion or severe stenosis at 24 hours was observed in 8.6% of cases. Follow-up imaging beyond day 1 (median 112 days, IQR 30-216) revealed two additional cases of stent occlusion (1.3%) at day 4 and 5. In-stent restenosis (at least 50%) was observed in 4.3% of cases after a median interval of 13 months; all these patients had underlying carotid atheroma. TLR was performed in 3% of cases. The cumulative incidences of restenosis at 1 and 2 years were 9.8% (95%CI 0.8-18.8) and 22% (95%CI 3.3-40.7%) respectively.

CONCLUSIONS: Stent occlusion was predominantly observed within the first 24 hours, with only rare occurrences thereafter. The incidence of long-term in-stent restenosis aligns with previously reported rates for elective CAS, performed outside the context of acute stroke EVT. Further prospective research is required to reduce the rates of stent occlusion within the first 24 hours.

ABBREVIATIONS: eCAS = emergent carotid artery stenting; EVT = endovascular treatment; TLR = target lesion revascularization; TL = tandem lesions; ICAO = isolated carotid artery occlusion; IQR = interquartile range; CAS = carotid artery stenting; LVO = large vessel occlusion; AIS = acute ischemic stroke; sICH = symptomatic intracranial hemorrhage; DAPT = dual antiplatelet treatment; mTICI = modified Thrombolysis in Cerebral Infarction scale; HI1, HI2 = hemorrhagic infarction type 1, type 2; PH1, PH2 = parenchymal hematoma type 1, type 2.

Footnotes

  • There are no relevant conflicting interests to declare for any of the authors.

  • © 2025 by American Journal of Neuroradiology

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Accepted Manuscript
Alexandru Dimancea, Axelle Y. Kern, Francois Severac, Anca Hasiu, Ian Leonard-Lorant, Roxana Gheoca, Emmanuel Wiener, Véronique Quenardelle, Valérie Wolff, Rémy Beaujeux, Pierre Mangin, Raoul Pop
Long term stent patency and revascularization rates after emergent carotid stenting during stroke thrombectomy
American Journal of Neuroradiology Apr 2025, ajnr.A8818; DOI: 10.3174/ajnr.A8818

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Accepted Manuscript
Long term stent patency and revascularization rates after emergent carotid stenting during stroke thrombectomy
Alexandru Dimancea, Axelle Y. Kern, Francois Severac, Anca Hasiu, Ian Leonard-Lorant, Roxana Gheoca, Emmanuel Wiener, Véronique Quenardelle, Valérie Wolff, Rémy Beaujeux, Pierre Mangin, Raoul Pop
American Journal of Neuroradiology Apr 2025, ajnr.A8818; DOI: 10.3174/ajnr.A8818
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