SystematIc StudY of Patients with atHerosclerotic neUrovascular Stenoses (SISYPHUS): Study Protocol for a Prospective Observational Cohort Evaluating 3D Rotational Angiography and Final Implant Quality in Carotid Stenting

The SISYPHUS study is a prospective multicenter observational cohort of 67 patients undergoing elective carotid artery stenting across three tertiary centers. The aim is to determine whether adding three-dimensional rotational angiography (3DRA) to standard digital subtraction angiography (DSA) improves characterization and reproducibility of final implant quality and provides incremental prognostic information for 90-day Textbook Outcome failure. Implant quality will be assessed using a structured 10-item instrument, with the primary clinical endpoint being 90-day Textbook Outcome failure including early neurological deterioration, major bleeding, stroke, TIA, myocardial infarction, death, and unplanned revascularization. Recruitment is complete (n=67), while protocol-defined follow-up remains ongoing. Formal reader evaluations have not yet begun.