Emergent carotid stenting during stroke endovascular treatment using the CARESTO heal stent: a multicenter experience

Purpose: Acute ischemic stroke due to tandem or cervical internal carotid artery (ICA) lesions is increasingly encountered, and the optimal carotid stent platform for emergent intervention remains uncertain. The aim of this study was to evaluate the technical feasibility, safety, and early outcomes of the CARESTO heal stent (Acandis GmbH, Pforzheim, Germany), the first coated carotid stent, in patients with acute ischemic stroke and extracranial ICA lesions undergoing endovascular treatment. Methods: We retrospectively analyzed consecutive patients with acute ischemic stroke and tandem occlusion, dissection, or acute-on-chronic extracranial ICA stenosis who underwent mechanical thrombectomy with concomitant CARESTO implantation at four centers between June 2024 and June 2025. Clinical, imaging, and procedural data were collected, and outcomes were summarized descriptively. Results: Ninety-two patients (mean age 63.2 years) were treated. CARESTO deployment in the cervical ICA was technically successful in all cases, with median post-stenting residual stenosis of 8% (IQR: 0–14). Successful intracranial reperfusion (mTICI ≥2 b) was achieved in 95.7% of patients, with neurological improvement (median National Institutes of Health Stroke Scale (NIHSS) 12, IQR: 8-16 at baseline to 4, IQR: 2-6 at 24 hours). At discharge, 44.9% of patients had a Modified Rankin Scale (mRS) score of 0–2 and 73.0% an mRS score of 0–3; in-hospital mortality was 5.4%. Symptomatic intracranial hemorrhage occurred in 7.6% and early in-hospital stent occlusion prior to discharge in 1.1%. Conclusion: Emergent carotid stenting with the CARESTO heal stent for acute ICA lesions was technically feasible, achieved high reperfusion rates, and showed an acceptable early safety and patency profile, supporting CARESTO as a promising option that warrants further comparative evaluation.