Overview of evidence on risk factors and early management of acute carotid stent thrombosis during the last two decades

Coelho, Andreia; Lobo, Miguel; Nogueira, Clara; Gouveia, Ricardo; Campos, J.B.L.M.; Augusto, Rita; Coelho, Nuno; Semião, Ana Carolina; Canedo, Alexandra

doi:10.1016/j.jvs.2018.09.053

Cited by 27 publications

(15 citation statements)

References 39 publications

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“…Non-intervention for CSO has not been studied, but it is likely to result in poor outcomes; comparison to patients who do not undergo thrombectomy for large vessel occlusions supports this hypothesis [29]. A recent systematic literature review found in nearly 60% of patients treated for CSO, that there was either no improvement after therapy or outcomes were not reported [30]. The same is true for nonuniform reporting of outcomes in the literature reviewed here.…”

Section: Discussionmentioning

confidence: 51%

Endovascular Treatment of Acute Carotid Stent Occlusion: Aspiration Thrombectomy and Angioplasty

Murray

Wolman

Marks

et al. 2020

Cureus

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Introduction Acute carotid stent occlusion (CSO) is a rare complication of endovascular carotid stent placement that requires emergent intervention. We describe angioplasty or combined angioplasty and aspiration thrombectomy as a new endovascular technique for CSO treatment. The technique is compared to others previously described in the literature. Methods We performed a retrospective cohort study of all patients who underwent endovascular treatment (ET) of acute symptomatic CSO from January 2008 to March 2018 at our neurovascular referral center. Patient demographics, endovascular treatment details, and outcome data were determined from the electronic medical record. Primary outcome was successful stent recanalization and cerebral reperfusion (modified thrombolysis in cerebral infarction (mTICI) score IIB-III). Secondary outcomes were National Institutes of Health Stroke Scale (NIHSS) shift from presentation to discharge, mortality, and modified Rankin Scale (mRS) score at 3 months. Additionally, a literature review (years 2008-2019) was performed to characterize other techniques for ET of CSO. Results Four patients who underwent ET of acute CSO were identified. ET treatment by angioplasty (n = 1) or combined aspiration thrombectomy and angioplasty (n = 3) resulted in carotid stent recanalization in all patients. Tandem intracranial occlusions were present in three patients (75%), and successful cerebral reperfusion was achieved in all patients. Patient symptoms improved (mean NIHSS shift-5.3 ± 7.2 at discharge). One patient died of a symptomatic reperfusion hemorrhage and another died of cardiac complications by 3-month follow-up. The mRS scores of the surviving patients were 1 and 3. Previously described studies (n = 14) using different and varied techniques had moderate recanalization rates and outcomes. Conclusion Combined aspiration thrombectomy and angioplasty for the neurointerventional treatment of acute CSO leads to high rates of stent recanalization and cerebral reperfusion. The recanalization rate here is improved compared to previously reported techniques. Further multicenter studies are required to riskstratify patients for specific ET interventions.

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Section: Discussionmentioning

confidence: 51%

Endovascular Treatment of Acute Carotid Stent Occlusion: Aspiration Thrombectomy and Angioplasty

Murray

Wolman

Marks

et al. 2020

Cureus

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“…Ruptured plaque may lead to in-stent restenosis during endothelium repair if the stent is inserted within 14 days, while stenting after the endometrial repair can decrease the rate of in-stent restenosis. Moreover, delayed stenting allowed patients more time for better medical preparation including dual antiplatelet therapy and controlling the risk factors to reduce the thromboembolic events and restenosis 23. In our study, all patients in the delayed group received dual antiplatelet therapy at least 5 days before stenting and the blood pressure was well controlled.…”

Section: Discussionmentioning

confidence: 69%

Early versus delayed stenting for intracranial atherosclerotic artery stenosis with ischemic stroke

Zhang

Sun

et al. 2019

J NeuroIntervent Surg

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ObjectiveTo evaluate the clinical outcomes of early stenting (≤14 days) or late stenting (>14 days) in patients who underwent intracranial stent placement.MethodsPatients with ischemic stroke caused by 70–99% intracranial atherosclerotic stenosis combined with poor collaterals were enrolled. The early stenting group, who underwent stenting within 14 days of last ischemic symptoms, were compared with the late stenting group who underwent stenting >14 days from last ischemic symptom. The patients were treated either with a balloon-mounted stent or a self-expanding stent as determined by the operators following a guideline. The baseline characteristics and clinical outcomes were evaluated and compared.ResultsOne hundred and fifteen stroke patients were recruited into the study. Four patients (4/41) in the early stenting group and two patients (2/74) in the late stenting group were diagnosed with a cerebral vascular event associated with stenting within 3 days (p=0.184). In the long-term follow-up, eight patients in the early stenting group had restenosis ≥50%, which was higher than patients in the late stenting group (8/41 vs 4/74, p=0.018). The total rates of any ischemic stroke, transient ischemic attack, hemorrhagic stroke, and death in the early stenting group were higher than in the late stenting group (9/41 vs 6/74, p=0.035). The recurrence rate of ischemic stroke in the early stenting group was higher than in the late stenting group (5/41 vs 2/74, p=0.041).ConclusionsStent placement in the setting of ischemic stroke caused by intracranial artery stenosis within 14 days may confer a higher risk of long-time cerebral vascular events and lead to a higher risk of restenosis.Clinical trial registrationNCT01968122.

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“…During the procedure, the median number of stents used and mean length of procedure were similar in both cohorts. Postoperatively, the median length of stay was comparable between both cohorts (2 days [1][2][3][4][5] in the TF cohort vs 2 days [1][2][3][4] in the TR cohort, P = .06). Finally, the median clinical and radiological follow-up duration was similar across both cohorts.…”

Section: Baseline Characteristicsmentioning

confidence: 89%

“…1-3 Stenosis of the carotid arteries typically arises as a consequence of atherosclerosis, which can be a result of modifiable and nonmodifiable risk factors. 4,5 Several landmark studies have corroborated the indications for carotid artery revascularization in patients who present with carotid artery stenosis, and carotid artery stenting (CAS) has emerged as a viable alternative for carefully selected patients who are deemed poor candidates for carotid endarterectomy.…”

mentioning

confidence: 99%

A Comparison of Outcomes Between Transfemoral Versus Transradial Access for Carotid Stenting

et al. 2023

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BACKGROUND: The transradial (TR) approach has emerged as an alternative to the transfemoral (TF) approach in carotid artery stenting (CAS) because of its perceived benefits in access site complications and overall patient experience. OBJECTIVE: To assess outcomes of TF vs TR approach for CAS. METHODS: This is a retrospective single-center review of patients receiving CAS through the TR or TF route between 2017 and 2022. All patients with symptomatic and asymptomatic carotid disease who underwent attempted CAS were included in our study. RESULTS: A total of 342 patients were included in this study: 232 underwent CAS through TF approach vs 110 through the TR route. On univariate analysis, the rate of overall complications was more than double for the TF vs TR cohort; however, this did not achieve statistical significance (6.5% vs 2.7%, odds ratio [OR] = 0.59 P = .36). The rate of cross-over from TR to TF was significantly higher on univariate analysis (14.6 % vs 2.6%, OR = 4.77, P = .005) and on inverse probability treatment weighting analysis (OR = 6.11, P < .001). The rate of in-stent stenosis (TR: 3.6% vs TF: 2.2%, OR = 1.71, P = .43) and strokes at follow-up (TF: 2.2% vs TR: 1.8%, OR = 0.84, P = .84) was not significantly different. Finally, median length of stay was comparable between both cohorts. CONCLUSION: The TR approach is safe, feasible, and provides similar rates of complications and high rates of successful stent deployment compared with the TF route. Neurointerventionalists adopting the radial first approach should carefully assess the preprocedural computed tomography angiography to identify patients amenable to TR approach for carotid stenting.

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Overview of evidence on risk factors and early management of acute carotid stent thrombosis during the last two decades

Cited by 27 publications

References 39 publications

Endovascular Treatment of Acute Carotid Stent Occlusion: Aspiration Thrombectomy and Angioplasty

Endovascular Treatment of Acute Carotid Stent Occlusion: Aspiration Thrombectomy and Angioplasty

Early versus delayed stenting for intracranial atherosclerotic artery stenosis with ischemic stroke

A Comparison of Outcomes Between Transfemoral Versus Transradial Access for Carotid Stenting

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