Clinical outcome of carotid artery stenting using dual layer stent for radiation induced carotid artery stenosis: Comparative study with single layer stent.

OBJECTIVE: Radiation-induced carotid artery stenosis (RICS) is a challenging late complication of radiotherapy for head and neck cancers, characterized by unstable plaques and fibrotic vessel walls. Dual-layer stents (DLS) have recently been developed to reduce periprocedural embolization and improve long-term durability. This study evaluated the safety and efficacy of DLS compared to conventional single-layer stents (SLS) in patients with RICS undergoing carotid artery stenting (CAS). METHODS: We retrospectively analyzed 20 patients with RICS and 86 patients with atherosclerotic internal carotid artery stenosis (AICS) who underwent CAS between 2014 and 2025. All patients with RICS had prior cervical radiotherapy and developed stenosis within the irradiated field. Eight patients received DLS (Casper stent), and 12 received SLS. Procedural and imaging data were reviewed. Ischemic lesions were assessed using diffusion-weighted imaging (DWI) on postoperative day 1. Long-term outcomes included ≥ 50% restenosis and retreatment. RESULTS: The proportion of patients with DWI-positive lesions did not differ significantly between the DLS and SLS groups (25.0% vs. 75.0%, p = 0.06); however, the number of DWI lesions per patient was significantly lower in the DLS group (0 [IQR, 0-1.5] vs. 1 [IQR, 0.8-2.0], p = 0.048). Stroke recurrence rates were similar between groups during the follow-up period. In addition, the DLS group showed at least comparative restenosis (0.0% vs. 25.0%, p = 0.242) and retreatment (0.0% vs. 16.7%, p = 0.495) rates. CONCLUSIONS: Use of DLS in RICS appears to reduce embolic burden while offering comparable long-term patency. These findings suggest that DLS represents a safe and feasible treatment option for RICS, warranting further prospective validation.