Résumé
Hintergrund: A recent retrospective single center study showed a rate of 45% of thrombotic occlusion of dual-layer carotid stents within 72 hours after emergent CAS during treatment of a tandem occlusion. (1) As the sample size in this study is small and this study appear to show a higher-than-anticipated occlusion rate, we hypothesize that the rate of occlusion is lower and rather comparable to previously reported occlusion rates in single layer stents and propose a retrospective multi-center evaluation to increase the power to assess this. Methoden: Multicentric retrospective data collection and analysis of stroke databases of 7 comprehensive stroke centers from 3 European countries. Ergebnisse: Overall 160 patients (age: mean (SD) = 66 (12); male: n = 104 (65%); median baseline NIHSS (IQR): 14 (9-18), IV lysis: n = 97 (60.6%) were treated for a cervical carotid artery occlusion or stenosis using a CASPER Stent (CASPER Stent, Carotid Artery Stent designed to Prevent Embolic Release, MicroVention, Aliso Viejo, CA) and received mechanical thrombectomy for an intracranial occlusion between April 2014 and November 2018. During the procedure or within 72 h, formation of thrombus and complete occlusion of the CASPER-Stent was observed in 33/160 patients (20.8%), respectively in 12/160 patients (7.5%). In 25/33 (75.8%), respectively in 9/12 patients (75%) this occurred during the procedure. No statistical significant difference was observed between patients with and without thrombus formation with regard to a pre-existing long-term medication with anticoagulants or intraprocedural administration of either heparin, ASA or heparin and ASA. Favorable early neurological outcome was similar in patients with (n = 15; 45.5%) and without (n = 63; 49.6%) thrombus formation at the CASPER-Stent. Diskussion: Fazit: Acute thrombosis or occlusion of CASPER-stents in thrombectomy patients receiving emergent extracranial internal carotid artery stenting for tandem occlusions can be observed more often during the procedure rather than within 72 h follow-up, were less frequent then previously reported and showed no impact on early neurological outcome.