Anthony Lamanna1, Julian Maingard2, Hong Kuan Kok3, Christen Barras4, Ashu Jhamb5, Vincent Thijs6, Ronil Chandra7, Duncan Mark Brooks8, Hamed Asadi9. 1. Interventional Radiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia. Electronic address: anton.lamanna92@gmail.com. 2. Interventional Neuroradiology Unit-Monash Imaging, Monash Health, Melbourne, Australia; School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Australia. 3. Interventional Radiology Service, Northern Hospital Radiology, Melbourne, Australia. 4. South Australian Health and Medical Research Institute, Adelaide, Australia; The University of Adelaide, Adelaide, Australia. 5. Department of Radiology, St. Vincent's Hospital, Melbourne, Australia. 6. Stroke Division, The Florey Institute of Neuroscience & Mental Health, University of Melbourne, Melbourne, Australia; The University of Melbourne, Melbourne, Australia; Department of Neurology, Austin Health, Melbourne, Australia. 7. Department of Imaging, Monash Health, Melbourne, Australia; Interventional Neuroradiology Unit-Monash Imaging, Monash Health, Melbourne, Australia. 8. Interventional Radiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia; Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia. 9. Interventional Radiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia; Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia; Department of Neurology, Austin Health, Melbourne, Australia; Department of Imaging, Monash Health, Melbourne, Australia; School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Australia.
Abstract
BACKGROUND: Carotid artery stenting (CAS) is an established treatment for carotid artery stenosis, typically in a semielective or elective setting. The growth of mechanical thrombectomy for acute stroke has led to an increased use of emergent carotid artery stenting (eCAS). This single-center retrospective case series evaluates the safety and efficacy of eCAS using a dual-layer micromesh nitinol stent to treat carotid artery stenosis in the acute stroke setting. METHODS: Ethics approval was granted by the institutional review board. Clinical data of all patients who underwent CAS using the Casper dual-layer micromesh nitinol stent system (MicroVention, Terumo, Tustin, California, USA) at a tertiary level 24-hour endovascular thrombectomy service over a 2-year period (June 2016-June 2018) were retrospectively obtained and reviewed. RESULTS: Twenty eCAS procedures were performed in 19 patients over the study period. Most patients had tandem lesions (12/20; 60%). Median National Institute of Health Stroke Scale score on admission was 17 (interquartile range 9-22). Stent deployment was technically successful in all patients. Recanalization rate was 95%. Symptomatic intracranial hemorrhage occurred in 2 patients (10%), both resulting in death. No other procedure-related deaths occurred. Stent thrombosis occurred in 2 patients. One delayed embolic stroke occurred. No other stent-related complications occurred. Median National Institute of Health Stroke Scale score at 24 hours postprocedure was 3 (interquartile range 1-12). Six patients had a good clinical outcome (modified Rankin Scale score between 0 and 2) at 3- to 6-month follow-up (38%). CONCLUSIONS: eCAS using the Casper stenting system is effective and technically feasible in the acute stroke setting, although the ideal antiplatelet and anticoagulation regime is not clearly established.
BACKGROUND: Carotid artery stenting (CAS) is an established treatment for carotid artery stenosis, typically in a semielective or elective setting. The growth of mechanical thrombectomy for acute stroke has led to an increased use of emergent carotid artery stenting (eCAS). This single-center retrospective case series evaluates the safety and efficacy of eCAS using a dual-layer micromesh nitinol stent to treat carotid artery stenosis in the acute stroke setting. METHODS: Ethics approval was granted by the institutional review board. Clinical data of all patients who underwent CAS using the Casper dual-layer micromesh nitinol stent system (MicroVention, Terumo, Tustin, California, USA) at a tertiary level 24-hour endovascular thrombectomy service over a 2-year period (June 2016-June 2018) were retrospectively obtained and reviewed. RESULTS: Twenty eCAS procedures were performed in 19 patients over the study period. Most patients had tandem lesions (12/20; 60%). Median National Institute of Health Stroke Scale score on admission was 17 (interquartile range 9-22). Stent deployment was technically successful in all patients. Recanalization rate was 95%. Symptomatic intracranial hemorrhage occurred in 2 patients (10%), both resulting in death. No other procedure-related deaths occurred. Stent thrombosis occurred in 2 patients. One delayed embolic stroke occurred. No other stent-related complications occurred. Median National Institute of Health Stroke Scale score at 24 hours postprocedure was 3 (interquartile range 1-12). Six patients had a good clinical outcome (modified Rankin Scale score between 0 and 2) at 3- to 6-month follow-up (38%). CONCLUSIONS: eCAS using the Casper stenting system is effective and technically feasible in the acute stroke setting, although the ideal antiplatelet and anticoagulation regime is not clearly established.
Authors: Yigit Ozpeynirci; Cristian Capatana; Johannes Rosskopf; Bernd L Schmitz; Gerhard F Hamann; Michael Braun Journal: Interv Neuroradiol Date: 2020-02-11 Impact factor: 1.610
Authors: Tomas Klail; Christoph Kurmann; Johannes Kaesmacher; Adnan Mujanovic; Eike I Piechowiak; Tomas Dobrocky; Sara Pilgram-Pastor; Adrian Scutelnic; Mirjam R Heldner; Jan Gralla; Pasquale Mordasini Journal: Clin Neuroradiol Date: 2022-09-07 Impact factor: 3.156