24-Hour Carotid Stent Patency and Outcomes After Endovascular Therapy: A Multicenter Study
Authors: Allard Julien , Delvoye François , Pop Raoul , Labreuche Julien , Maier Benjamin , Marnat Gaultier , Sibon Igor , Zhu François , Lapergue Bertrand , Consoli Arturo , Spelle Laurent , Denier Christian , Richard Sébastien , Piotin Michel , Gory Benjamin , Mazighi Mikael , Blanc Raphael , Redjem Hocine , Escalard Simon , Dessilles Jean-Philippe , Delvoye François , Smajda Stanislas , Maier Benjamin , Solène Hebert , Mazighi Mikael , Obadia Mikael , Sabben Candice , Pierre Seners , Igor Raynouard , Corabianu Ovide , de Broucker Thomas , Manchon Eric , Taylor Guillaume , Maacha Malek Ben , Thion Laurie-Anne , Augustin Lecler , Julien Savatovsjy , Wang Adrien , Evrard Serge , Tchikviladze Maya , Ajili Nadia , WeisenburgerLile David , Gorza Lucas , Buard Géraldine , Coskun Oguzhan , Di Maria Federico , Rodesh Georges , Zimatore Sergio , Leguen Morgan , Gratieux Julie , Pico Fernando , Rakotoharinandrasana Haja , Tassan Philippe , Poll Roxanna , Marinier Sylvie , Barreau Xavier , Berge Jérôme , Menegon Patrice , Lucas Ludovic , Olindo Stéphane , Renou Pauline , Sagnier Sharmila , Poli Mathilde , Debruxelles Sabrina , Rouanet François , Tourdias Thomas , Liegey Jean-Sebastien , Briau Pierre , Pangon Nicolas , Coussy Alexis , Papillon Lisa , Papaxanthos Jean , Detraz Lili , Daumas-Duport Benjamin , Alexandre Pierre-Louis , Roy Monica , Lenoble Cédric , Desal Hubert , Guillon Benoît , de Gaalon Solène , Preterre Cécile , Bracard Serge , Anxionnat René , Braun Marc , Derelle Anne-Laure , Tonnelet Romain , Liao Liang , Zhu François , Schmitt Emmanuelle , Planel Sophie , Humbertjean Lisa , Lacour Jean-Christophe , Riou-Comte Nolwenn , Voicu Marcela , Alb Lionel , Reitter Marie , Brezeanu Madalina , Masson Agnès , Tabarna Adriana , Podar Iona , Macian-Montoro Francisco , Saleme Suzanna , Mounayer Charbel , Rouchaud Aymeric , Costalat Vincent , Arquizan Caroline , Dargazanli Cyril , Gascou Grégory , Lefèvre Pierre-Henri , Derraz Imad , Riquelme Carlos , Gaillard Nicolas , Mourand Isabelle , Corti Lucas , Cagnazzo Federico , Ter Schiphorst Adrien , Ferre Jean-Christophe , Raoult Hélène , Ronziere Thomas , Lassale Maria , Paya Christophe , Gauvrit Jean-Yves , Tracol Clément , Langnier-Lemercier Sophie 
Published: December 2022

Background:
Management of extracranial internal carotid artery steno-occlusive lesion during endovascular therapy remains debated. Stent occlusion within 24 hours of endovascular therapy is a frequent event after acute carotid artery stenting, and we currently lack large population results. We investigated the incidence, predictors, and clinical impact of stent occlusion after acute carotid artery stenting in current clinical practice.

Methods:
Patients treated by endovascular therapy with acute carotid artery stenting between 2015 and 2019 in 5 large-volume endovascular-capable centers were retrospectively analyzed. Patients were separated in 2 groups according to the stent patency at 24 hours after carotid artery stenting. We compared baseline characteristics, treatment modalities, and clinical outcome depending on 24-hour stent patency. Primary end point was favorable outcome, defined as a modified Rankin Scale score 0–2 at 3 months.

Results:

A stent occlusion was observed in 47/225 patients (20.9%). Patients with stent patency had a lower baseline National Institutes of Health Stroke Scale (median [interquartile range]: 13 [7–17] versus 18 [12–21]) and had more often stroke of atherothrombotic origin (77.0% versus 53.2%). A higher stent patency rate was found for patients treated with P2Y
12
antagonists at the acute phase (odds ratio [OR]‚ 2.95 [95% CI‚ 1.10–7.91];
P
=0.026) and treated with angioplasty (OR‚ 2.42 [95% CI‚ 1.24–4.67];
P
=0.008). A better intracranial angiographic reperfusion was observed in patients with 24-hour stent patency compared with patients without stent patency (OR‚ 8.38 [95% CI‚ 3.07–22.78];
P
<0.001). Patients with a stent patency at 24 hours had a higher chance of favorable outcome (OR‚ 3.29 [95% CI, 1.66–6.52];
P
<0.001) and a lower risk of death (OR‚ 0.32 [95% CI, 0.13–0.76];
P
=0.009).

Conclusions:

One out of 5 patients treated with carotid artery stenting during endovascular therapy presented a stent occlusion within 24 hours. This event was associated with worse functional outcome. Stroke etiology, P2Y
12
antagonist administration, quality of intracranial reperfusion, and angioplasty were associated with 24-hour stent patency.