Preliminary Experience Using a Covered Stent Graft in Patients with Acute Ischemic Stroke and Carotid Tandem Lesion

Abstract

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. ConclusionThe 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.

Application of covered stent graft in the treatment of complex carotid artery lesions: A single center experience

“…A major theoretical advantage to use Viabahn stent is that the bioactive heparin coating provides thrombosis resistance and an antiproliferative effect to prevent neointimal hyperplasia, and this feature may be retained for at least 3 months. 6,36 Previous reports suggested 11 that proximal or distal dissection, small vessel size, and stent length are all significantly associated with in-stent thrombosis. More trials are necessary to determine the variables related to thrombotic events during covered stent implantation.…”

“…5 Covered stent grafts have been documented for the treatment of complex carotid artery lesions. [6][7][8][9][10][11] They not only provided immediate obliteration of the lesion but also preserved the normal lumen of the parent artery and promoted the growth and coverage of new endothelial cells 12 ; nevertheless, the challenges of thrombosis, stenosis, and the vessel structure may restrict the implantation. 13 The optimal endovascular treatment strategy for complex carotid artery lesions is yet to reach consensus.…”