Dual-layer carotid stenting for symptomatic carotid web: Results from the Caroweb study.

Gaultier Marnat
Quentin Holay
Jean Darcourt
Jean-Philippe Desilles
Michaël Obadia
Alain Viguier
Jildaz Caroff
Christian Denier
Lisa Papillon
Xavier Barreau
Christophe Cognard
Jerome Berge
Quentin Bourgeois-Beauvais
Anne Landais
Marion Boulanger
Francisco Macian
Benoit Guillon
Fernando Pico
Mathias Lamy
Emmanuelle Robinet-Borgomano
Sébastien Richard
Benjamin Gory
Igor Sibon
Nicolas Gaillard
Nicolas Chausson
Stephane Olindo

Source: J Neuroradiol

Publié le 1 juin 2023

Résumé

BACKGROUND & PURPOSE: Carotid Web (CaW) is a growingly recognized cause of ischemic stroke, associated with a high recurrence risk. Several therapeutic strategies have been proposed as a tertiary prevention including carotid stenting, endarterectomy and antithrombotic medications. Among these, carotid stenting with dual-layer stent may be promising to adequately cover the focal arterial dysplasia. Our aim was to investigate the safety and efficacy of the Casper stent in the treatment of symptomatic CaW.

METHODS: We conducted a retrospective analysis of consecutive patients presenting with a symptomatic CaW and included in the ongoing prospective observational multicenter CAROWEB registry. The study period was January 2015 to December 2021. Inclusion criteria were CaW treated with dual-layer Casper stent. Patients treated with other types of carotid stent, endarterectomy or antithrombotic medication were excluded. Clinical and radiological initial data and outcomes were recorded.

RESULTS: twenty-seven patients (with 28 caw) were included. median age was 52 (iqr: 46-68). median delay between index cerebrovascular event and cervical stenting was 9 days (IQR: 6-101). In all cases, the cervical carotid stenting was successfully performed. No major perioperative complication was recorded. No recurrent stroke or transient ischemic attack was observed during a median follow-up time of 272 days (IQR: 114-635). Long-term imaging follow-up was available in 25/28 (89.3%) stented CaW with a median imaging follow-up of 183 days (IQR: 107-676; range: 90-1542). No in-stent occlusion or stenosis was detected.

CONCLUSION: In this study, carotid stenting with dual-layer Casper stent in the treatment of symptomatic CaW was effective regarding stroke recurrence prevention and safe, without procedural nor delayed detected adverse event. However, the optimal therapeutic approach of symptomatic CaW still needs to be explored through randomized trials.