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Published on: May 14, 2013
Preliminary Experience Using a Covered Stent Graft in Patients with Acute Ischemic Stroke and Carotid Tandem Lesion
Carlos Piñana1,2, Laura Ludovica Gramegna3,4, Edgar Folleco2
1Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
Insights
Covered stent grafts showed poor 90-day patency in acute ischemic stroke patients with tandem carotid lesions. This endovascular treatment may not be recommended for carotid artery intervention in stroke cases.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Cardiology
Background:
- Endovascular treatment with covered stent grafts is established for peripheral artery disease.
- Its efficacy in carotid artery disease, particularly for acute ischemic stroke (AIS), is not well-defined.
Purpose of the Study:
- To evaluate the feasibility and safety of using a self-expanding covered stent graft for cervical carotid artery disease in patients with AIS due to tandem lesions.
Main Methods:
- Retrospective review of eight patients undergoing carotid endovascular intervention with a covered stent graft during mechanical thrombectomy for AIS.
- Data collected included clinical and angiographical characteristics, postoperative outcomes, and 3-month follow-up.
Main Results:
- Significant improvement in stroke severity at 24 hours in 5/8 patients (p=0.02).
- Successful recanalization (TICI 2b-3) achieved in 62.5% of patients.
- At 3-month follow-up, only 37.5% of stents remained patent; 62.5% occluded, though without stroke recurrence.
Conclusions:
- The self-expanding covered stent graft demonstrated unsatisfactory 90-day patency rates in patients with AIS and tandem carotid lesions.
- Current findings suggest this device may not be advisable for carotid intervention in the context of acute ischemic stroke.
Introduction:
Endovascular treatment with a covered heparin-bonded stent graft has been shown to be feasible and safe for treatment of peripheral artery disease, but its role in carotid disease remains unclear. The purpose of this study was to determine the feasibility and safety of a covered stent graft in treating cervical carotid artery disease in a consecutive series of patients with acute ischemic stroke (AIS) due to tandem lesion in a single high-volume Comprehensive Stroke Center.
Methods:
A retrospective review of all patients that underwent carotid endovascular interventions during mechanical thrombectomy for AIS using a self-expanding covered stent graft at Vall d'Hebron University Hospital between 2016 and 2018 was conducted. Patient clinical and angiographical characteristics as well as postoperative outcome and follow-up were recorded.
Results:
A total of eight patients were treated with the covered stents, and we observed significant improvement in stroke severity at 24 h in 5/8 patients (mean NIHSS 18 ± 5 vs 12 ± 8, p = 0.02). Successful recanalization (TICI 2b-3) after thrombectomy was achieved in 5/8 (62.5%) patients. One stent occluded during the procedure. At 3-month follow-up, stents were patent in three (37.5%) patients (two with mRS 3 and one with mRS 1). The stents of the remaining four patients (62.5%) were occluded (one with mRS 2 and three with mRS 4), although the patients did not show signs of stroke recurrence.
Conclusion:
The preliminary results of our study show that the self-expanding covered stent graft did not achieve satisfactory patency at 90-days among patients with AIS and tandem lesions, suggesting that its use in the carotid circulation may not be recommended in the context of AIS.
