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

  • Clinical Investigation
  • Stroke/Neurointerventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

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.

Conclusion

The 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.

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Acknowledgements

The authors acknowledge the team of the Interventional Neuroradiology Section of the Valld’Hebron Hospital in Barcelona, Spain, and Superior Medical Experts for editing support.

Funding

This study was not supported by any external funding.

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Authors and Affiliations

  1. Interventional Neuroradiology Section, Department of Radiology, Vall d′Hebron University Hospital, Pg. Vall d’Hebron, 119-129, 08035, Barcelona, Spain

    Carlos Piñana, David Hernandez & Alejandro Tomasello Weitz

  2. Vall d′Hebron Research Institute (VHIR), Vall d′Hebron University Hospital, Barcelona, Spain

    Carlos Piñana, Edgar Folleco, Manuel Requena, David Hernandez & Alejandro Tomasello Weitz

  3. IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy

    Laura Ludovica Gramegna

  4. Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy

    Laura Ludovica Gramegna

  5. Stroke Unit, Department of Neurology, Vall d′Hebron University Hospital, Barcelona, Spain

    Manuel Requena

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Correspondence to Alejandro Tomasello Weitz.

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Piñana, C., Gramegna, L.L., Folleco, E. et al. Preliminary Experience Using a Covered Stent Graft in Patients with Acute Ischemic Stroke and Carotid Tandem Lesion. Cardiovasc Intervent Radiol 43, 1679–1686 (2020). https://doi.org/10.1007/s00270-020-02594-3

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