Off-Label Stent as a Rescue Option for Angulated Proximal Internal Carotid Artery Stenosis in Technically Unfeasible...

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Neurology

Background:

• Extracranial internal carotid artery (ICA) stenosis poses a significant risk for stroke.
• Anatomically challenging cases often limit treatment options like carotid endarterectomy (CEA) and conventional carotid artery stenting (CAS).
• Off-label use of intracranial stents may be a viable alternative in these complex scenarios.

Purpose of the Study:

• To assess the feasibility, safety, and short-term outcomes of using off-label intracranial stents for extracranial ICA revascularization.
• To evaluate this strategy in patients with anatomically challenging proximal ICA stenosis where standard revascularization is unfeasible.

Main Methods:

• Retrospective multicenter cohort study of 1,522 patients undergoing carotid revascularization (2017-2025).
• Compared three groups: off-label intracranial stent use, conventional CAS, and CEA.
• Analyzed technical success, 30-day mortality, 3-month restenosis (≥50%), and functional outcome (modified Rankin Scale ≤2).

Main Results:

• The off-label group (n=48) had higher rates of near-occlusion/occlusion (68.8%) and symptomatic presentation (100%) compared to CAS and CEA.
• Technical success was high across all groups (100% off-label/CEA, 99.4% CAS).
• Thirty-day mortality and 3-month restenosis rates were comparable. Functional independence significantly improved in the off-label group (31.3% to 100%).

Conclusions:

• Off-label stenting demonstrates high technical feasibility and acceptable safety in complex proximal ICA stenosis.
• This approach leads to meaningful functional recovery, serving as a potential rescue option for carefully selected patients.
• It addresses limitations of CEA and standard CAS in anatomically difficult cases.