Technical Effectiveness and Safety of Emergent Stenting in Patients With Acute Ischemic Stroke and Carotid Near-Occlusion

BACKGROUND: The increased very early risk (within the first 2 days after presenting event) of recurrent stroke among patients with symptomatic carotid near-occlusion (SCNO) and full collapse (FC) might justify ultra-early carotid revascularization of these patients. However, we lack data about technical effectiveness and safety of this approach in SCNO. This study aims to assess the feasibility and safety of emergent carotid stenting (eCAS) in patients with SCNO. METHODS: multicenter study including patients with acute stroke and extracranial carotid stenosis or occlusion undergoing mechanical thrombectomy and eCAS. The main outcomes were revascularization failure (incomplete carotid revascularization/occlusion at 48h), intracerebral hemorrhage (ICH) and symptomatic ICH (sICH). Patients with SCNO with and without FC were compared with the remaining patients. RESULTS: 309 patients were included, 215 (69.6%) males, mean age (SD) 67.2 (12.8). 52 patients had SCNO and 18 SCNO+FC. Revascularization failure occurred in 16% of SCNO and in 15.2% of the remaining patients (p=0.884), with no differences between SCNO with or without FC. ICH was more common in patients with SCNO (37% for all SCNO, 41% for SCNO+FC, and 23% for the remaining patients; p=0.033). This increased risk of ICH associated with SCNO persisted in the multivariate analysis (OR 2.84 [95%CI 1.41 – 5.71], p=0.003). The rate of sICH was identical (6%) for SCNO and the rest of patients. CONCLUSIONS: The use of eCAS in acute SCNO seems to be feasible. However, the safety of the procedure is uncertain, as it could be associated with an increased risk of ICH.