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Background <p>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.</p> Methods <p>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.</p> Results <p>309 patients were included, 215 (69.6%) males, mean age (SD) 67.2 (12.8). 45 patients had SCNO and 16 SCNO + FC. Revascularization failure occurred in 15.6% of SCNO and in 13.4% of the remaining patients (p = 0.826), with no differences between SCNO with or without FC. ICH was more common in patients with SCNO (42% for all SCNO, 47% for SCNO + FC, and 24% for the remaining patients; p = 0.027). This increased risk of ICH associated with SCNO persisted in the multivariate analysis (OR 3.49 [95%CI 1.63 – 7.48], p = 0.001). No significant differences in the rate of sICH were observed between SCNO and the remaining patients.</p> Conclusions <p>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.</p>

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Technical effectiveness and safety of emergent stenting in patients with acute ischemic stroke and carotid near-occlusion

  • 期刊论文

  • 发表日期：

    2025年9月30日

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  • Andrés García Pastor,
  • Isabel Lera Ramírez,
  • Alejandro Bonilla Tena,
  • David Seoane,
  • Patricia Calleja,
  • Fernando Ostos,
  • Elena De Celis-Ruiz,
  • Carlos Gómez Escalonilla,
  • Patricia Simal,
  • Alfonso López-Frías López-Jurado,
  • Daniel Perez Gil,
  • Rocío Vera Lechuga,
  • Cristina Moreno-López,
  • Jose Carlos Fernandez-Ferro,
  • María Teresa Montalvo Moraleda,
  • Javier Roa Escobar,
  • Araceli García Torres,
  • Inmaculada Navas Vinagre,
  • Eduardo Escolar Escamilla,
  • Rodrigo Terrero Carpio,
  • Guillermo Martín Ávila,
  • Ana María Iglesias Mohedano,
  • Marta Vales Montero,
  • Antonio Gil Núñez

摘要

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). 45 patients had SCNO and 16 SCNO + FC. Revascularization failure occurred in 15.6% of SCNO and in 13.4% of the remaining patients (p = 0.826), with no differences between SCNO with or without FC. ICH was more common in patients with SCNO (42% for all SCNO, 47% for SCNO + FC, and 24% for the remaining patients; p = 0.027). This increased risk of ICH associated with SCNO persisted in the multivariate analysis (OR 3.49 [95%CI 1.63 – 7.48], p = 0.001). No significant differences in the rate of sICH were observed between SCNO and the remaining 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.