Mid-term outcomes of carotid artery stenting in patients with angiographic string sign

Abstract

Objectives: To report on early and mid-term outcomes of carotid artery stenting (CAS) in patients with angiographic string sign (SS).

Background: Little is known about the prognosis of patients with carotid SS treated by CAS.

Methods: We retrospectively evaluated early and mid-term outcomes, together with ultrasound findings, in patients with SS treated by CAS at our institution.

Results: Of 308 CAS procedures, SS was diagnosed in 6.2% (19 patients, 58% symptomatic). Carotid stent implantation was successful in 18 patients (success rate 95%). There were no peri-procedural adverse events. One patient suffered from a transient ischemic attack during hospitalization and died of pneumonia. All remaining patients completed a 30-day follow-up, and no complications were reported (asymptomatic restenosis was diagnosed in 1 patient and successfully redilated). Six patients died of causes unrelated to CAS (pneumonia, decompensated heart failure, and contralateral stroke) before completing a 6-month follow-up. However, these patients presented with more pronounced, unfavorable clinical and angiographic characteristics compared to the rest of the patients.

Conclusions: We suggest that CAS might be performed with acceptable procedural risk in patients presenting with SS, which is unsuitable for surgery. However, patients' clinical and angiographic characteristics must be carefully evaluated when considering interventional therapy, regardless of the favorable procedural outcomes.