Flow-Diverting Stents During Mechanical Thrombectomy for Carotid Artery Dissection-Related Stroke: Analysis from a
Osama Elshafei1,2, Jonathan Cortese1,3, Nidhal Ben Achour4
1NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University-Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicetre, France.
Background And Purpose:
Mechanical thrombectomy in the context of internal carotid artery dissection (ICA-D) lesions is an undesirable procedure that may necessitate carotid stenting. Flow-diverting stents (FDSs) are promising devices with numerous advantages, particularly in cases involving tortuous anatomy. Here, we investigate the use of FDSs in the acute management of carotid dissection during mechanical thrombectomy procedures in patients with dissection-related strokes.
Materials And Methods:
This was a multicentric retrospective observational study of consecutive patients admitted for mechanical thrombectomy due to acute ischaemic stroke with ICA-D and treated with an FDS in the acute setting between July 2018 and February 2023. Patient records, procedural details, and post-procedural outcomes, including follow-up data, were reviewed.
Results:
A total of 11 patients (10 patients with unilateral ICA-D and one patient with bilateral ICA-D) were included, 10 of whom were male, with a median age of 54 years (range: 35-85 years) and NIHSS scores at admission ranging from 3 to 32 (median 13). Eight cases (73%) involved intracranial occlusion (tandem stroke), with the intracranial occlusion managed first each time. An FDS was selected when the dissection was long and/or the ICA was tortuous, and successful deployment was achieved in all patients with a favourable angiographic outcome (TICI 2B-3). A favourable outcome (modified Rankin scale 0-2 at 90 days) was observed in five patients (45%), with four patients (36%) experiencing symptomatic ICH and three patients having stent occlusion out of the 12 treated ICA-D cases.
Conclusions:
The use of FDSs for acute stenting in ICA-D-related stroke can be performed efficiently, resulting in excellent angiographic outcomes and an acceptable rate of favourable outcomes specific to the pathology. Larger prospective studies are still needed to confirm the potential benefits of FDSs in acute situations.
