Emergency Carotid Artery Stenting in Acute Ischemic Stroke Due to Cervical Internal Carotid Artery Occlusion or Stenosis: A Single-Center Experience

Objective: This study aims to comprehensively evaluate the effectiveness and safety of emergency carotid artery stenting (CAS) in a selected patient population by consolidating the outcomes of CAS procedures. Methods: A total of 230 patients who underwent CAS at our interventional radiology unit between January 1, 2020, and July 31, 2024, were retrospectively evaluated. Among these, 35 patients who received emergency CAS due to hemodynamic instability and high National Institutes of Health Stroke Scale (NIHSS) scores (>4) at initial admission; increased frequency of transient ischemic attacks (TIA) during follow-up; clinical deterioration in acute infarction; decline in Glasgow Coma Scale (GCS) scores and consciousness; significantly impaired flow due to dissection; or balloon resistance in tandem occlusion were included in the study. Procedural complications, technical and clinical success, modified Rankin Scale (mRS) scores, and mortality rates were recorded. Results: Of the 35 patients included, 57.2% (n=20) were male, with a mean age of 67.5 ± 9.4 years. Comorbidities were present in 77.1% (n=27) of the patients, with hypertension being the most common (n=21, 60%). Lesions were located in the right carotid artery in 57.2% (n=20) of cases, and the most frequent degree of stenosis was between 70–90% (n=21, 60%). CAS was performed in 5 patients (14.2%) due to flow-limiting dissection. Predilatation and postdilatation were performed in 20 (57.1%) and 25 (77.1%) patients, respectively, and distal embolic protection filters were used in 20 (57.1%) patients. Procedural vasospasm occurred in 7 patients (20%). Persistent hypotension was observed in 1 patient (2.8%), and hyperperfusion-related hemorrhage occurred in 3 patients (8.6%). Two patients (5.7%) required intensive care unit (ICU) stay longer than 48 hours. At 3 months, 32 patients (91.4%) demonstrated favorable clinical outcomes (mRS ≤ 2). Mortality occurred in one patient (2.8%) due to myocardial infarction. Conclusion: Emergency CAS offers acceptable early safety and efficacy outcomes in patients with symptomatic high-grade carotid artery stenosis. The findings suggest that emergency CAS may be a viable therapeutic option in selected patients. However, further prospective, randomized controlled, multicenter studies are warranted to validate these results.