Long-Term Stent Patency and Revascularization Rates after Emergent Carotid Stenting during Stroke Thrombectomy

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

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 or isolated carotid artery occlusion (ICAO), between November 2009 and September 2024.

A total of 220 patients were included in the study, of whom 207 had tandem lesions 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, interquartile range, 30-216) revealed 2 additional cases of stent occlusion (1.2%) 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.

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 carotid artery stent placement, 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.