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Pini R, Faggioli G, Paraskevas KI, Campana F, Sufali G, Rocchi C, Palermo S, Gallitto E, Gargiulo M. Carotid Artery Stenting With Double-Layer Stent: A Systematic Review and Meta-Analysis. J Endovasc Ther 2024; 31:339-349. [PMID: 36214459 PMCID: PMC11110467 DOI: 10.1177/15266028221126940] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Carotid artery stenting (CAS) in the treatment of significant stenosis is a cause of stroke due to both plaque prolapse and cerebral embolization. New types of stents with a double-layer structure have been designed to minimize plaque prolapse and embolization; these double-layer stents (DLSs) should be able to reduce the stroke risk; however, definite data on their performance are scarce in the literature. METHODS A systematic search was performed through PubMed, Scopus, and Cochrane Library, according to PRISMA guidelines; all studies on CAS with DLS (Roadsaver/Casper or CGuard) up to January 1, 2022, with a cohort of at least 20 patients were considered eligible. The present meta-analysis was approved and registered on PROSPERO register (CRD42022297512). Patients with tandem lesions or complete carotid occlusion were excluded from the study. The 30-day stroke rate after CAS was analyzed evaluating the preoperative symptomatic status and DLS occlusion. The estimated pooled rate of events was calculated by random effect model and moderators were evaluated. RESULTS A total of 14 studies were included in the meta-analysis for a total of 1955 patients. The estimated overall (95% confidence interval [CI]) stroke rate was 1.4% (0.9%-2.2%, I2 = 0%), which was not influenced by the type of DLS used: CGuard 0.8% (0.4%-1.8%, I2 = 0%) versus Roadsaver/Casper 1.5% (0.7%-3.2%, I2 = 0%), p=0.30. The 30-day estimated stroke rate was 1.5% (0.8%-2.9%, I2 = 0%) in asymptomatic and 1.9% (1.0%-3.6%, I2 = 0%) in symptomatic patients, with no influence by moderators. The 30-day DLS occlusion rate was 0.8% (0.4%-1.8%, I2 = 0%). The publication bias assessment identified asymmetry in the asymptomatic populations. CONCLUSION The overall 30-day stroke rate in CAS with DLS is low (1.4%), with similar results in symptomatic and asymptomatic patients. Acute occlusion of DLS is rare (0.8%). Further studies are necessary to reduce the publication bias for asymptomatic patients. CLINICAL IMPACT CAS with DLS is associated to a low rate of 30-day stroke in both symptomatic (1.9%) and asymptomatic (1.5%) patients. The type of DLS (CGuard or Roadsaver/Casper) did not affect the 30-day stroke rate.
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Affiliation(s)
- Rodolfo Pini
- Department of Vascular Surgery, University of Bologna and Policlinico Sant’Orsola Malpighi, Bologna, Italy
| | - Gianluca Faggioli
- Department of Vascular Surgery, University of Bologna and Policlinico Sant’Orsola Malpighi, Bologna, Italy
| | | | - Federica Campana
- Department of Vascular Surgery, University of Bologna and Policlinico Sant’Orsola Malpighi, Bologna, Italy
| | - Gemmi Sufali
- Department of Vascular Surgery, University of Bologna and Policlinico Sant’Orsola Malpighi, Bologna, Italy
| | - Cristina Rocchi
- Department of Vascular Surgery, University of Bologna and Policlinico Sant’Orsola Malpighi, Bologna, Italy
| | - Sergio Palermo
- Department of Vascular Surgery, University of Bologna and Policlinico Sant’Orsola Malpighi, Bologna, Italy
| | - Enrico Gallitto
- Department of Vascular Surgery, University of Bologna and Policlinico Sant’Orsola Malpighi, Bologna, Italy
| | - Mauro Gargiulo
- Department of Vascular Surgery, University of Bologna and Policlinico Sant’Orsola Malpighi, Bologna, Italy
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Stefanini M, Cacioppa LM, Bellini L, Ginanni Corradini L, D'Onofrio A, Simonetti G. Dual-layered micromesh stent technology for embolic prevention in carotid revascularization: technical experience and clinical outcomes from a high-volume interventional radiology center. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:213-220. [PMID: 38727642 DOI: 10.23736/s0021-9509.24.13033-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
BACKGROUND Carotid artery stenting (CAS) has become a cornerstone of carotid revascularization for stroke prevention. Despite the advantages of CAS, large-scale randomized trials involving prior (single-layer) first generation stents (FGS) demonstrated a higher risk of periprocedural cerebrovascular events compared to surgery. Dual-layer mesh-covered stents (DLSs) showed promising results in terms of 30-day embolic events in initial studies; larger-scale evidence is accumulating. This study aims to evaluate 30-day clinical efficacy of DLS against a closed-cell stent, based on large-volume data. METHODS The study center is part of the Italian National Outcomes Evaluation Program (PNE). CAS procedures performed between November 2017 and September 2023 were eneterd into a prospectively collected database. Our The primary endpoint was survival free of death, stroke, and myocardial infarction (MI) at 30 days. In addition, technical success and periprocedural major adverse clinical event rate (with a focus on stroke) were also evaluated. RESULTS Over a total of 1101 CAS procedures (745 males; mean age 79±7.8 years), 48.6% were symptomatic. Majority (80.2%) were treated with DLSs. Technical success was achieved in 98.9%. The FGSs group showed a significantly higher peri-procedural stroke rate when compared with CGuard and Roadsaver DLS: 4.59% vs. 1.18% vs. 2.63% (P=0.008); minor stroke rates were 4.13% vs. 0.83% and 0% P=0.01). The cumulative stroke, MI and death - free survival at 30 days was 97.46%. A statistically significant higher cumulative 30-day death/stroke/MI rate occurred in FGSs-treated patients compared to the CGuard and Roadsaver DLS-treated (6.42% vs. 1.42% and 2.63%, P=0.001). CONCLUSIONS The use of DLS in patients undergoing CAS in our large-volume center showed a high technical success rate and minimal cerebral embolic complications by 30 days. High volumes and an experienced interventional team may contribute to these favorable outcomes.
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Affiliation(s)
- Matteo Stefanini
- Department of Diagnostic Imaging and Interventional Radiology, Casilino Hospital, Rome, Italy
| | - Laura Maria Cacioppa
- Department of Clinical, Special and Dental Sciences, Polytechnic University of Marche, Ancona, Italy
- Division of Interventional Radiology, Department of Radiological Sciences, Azienda Ospedaliera Universitaria della Marche University Hospital, Ancona, Italy
| | - Luigi Bellini
- Department of Diagnostic Imaging and Interventional Radiology, Casilino Hospital, Rome, Italy -
| | - Luca Ginanni Corradini
- Department of Diagnostic Imaging and Interventional Radiology, Casilino Hospital, Rome, Italy
| | - Adolfo D'Onofrio
- Department of Diagnostic Imaging and Interventional Radiology, Casilino Hospital, Rome, Italy
| | - Giovanni Simonetti
- Department of Diagnostic Imaging and Interventional Radiology, Casilino Hospital, Rome, Italy
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Kedev S. Carotid artery interventions - endarterectomy versus stenting. ASIAINTERVENTION 2023; 9:172-179. [PMID: 37736202 PMCID: PMC10509610 DOI: 10.4244/aij-d-23-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/02/2023] [Indexed: 09/23/2023]
Abstract
Current management of patients with carotid artery stenosis is based on well-established guidelines, including surgical procedures - carotid endarterectomy (CEA) and endovascular carotid artery stenting (CAS) - and optimal medical treatment alone. Outcomes in the postprocedural period after CAS and CEA are similar, suggesting strong clinical durability for both treatments. Recent advances, which include the emergence of novel endovascular treatment tools and techniques, combined with more recent randomised trial data shed new light on optimal patient selection and treatment in contemporary practice. Improved, modern technologies including enhanced embolic protection devices and dual-layered micromesh stents yield better outcomes and should result in further improvements in CAS. In centres of excellence, nowadays, the majority of patients with severe carotid artery stenosis can be successfully treated with either CEA or CAS.
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Affiliation(s)
- Sasko Kedev
- University Clinic of Cardiology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
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Okumura E, Onodera S, Jimbo H. Subacute In-Stent Occlusion 2 Weeks after CASPER Rx Stenting: A Case Report. JOURNAL OF NEUROENDOVASCULAR THERAPY 2023; 17:173-179. [PMID: 37609575 PMCID: PMC10442173 DOI: 10.5797/jnet.cr.2023-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/03/2023] [Indexed: 08/24/2023]
Abstract
Objective CASPER Rx stent (Terumo, Tokyo, Japan) is one of the dual-layer micromesh stents for carotid artery stenosis. Although it is expected to be safe and efficacious even for vulnerable plaque, we report a case of in-stent occlusion 2 weeks after stenting with CASPER Rx stent. Case Presentation The patient was a 78-year-old man with a symptomatic, severely stenosed lesion of the cervical internal carotid artery (ICA). He had an unstable plaque and underwent carotid artery stenting with the CASPER Rx stent. There were no problems with the procedure or the patient's subsequent course, and he was discharged home 1 week after the procedure. However, on postoperative day 14, the patient had a transit ischemic attack and imaging showed acute occlusion due to thrombus in the stent and in the distal part of the ICA. Mechanical thrombectomy was performed and good recanalization was achieved, but postoperative cerebral infarction was observed and the patient was transferred to other hospital with modified Rankin Scale 2. Conclusion We experienced a case of in-stent occlusion 2 weeks after stenting with the CASPER Rx stent.
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Affiliation(s)
- Eitaro Okumura
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Sho Onodera
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Hiroyuki Jimbo
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
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Langhoff R, Petrov I, Kedev S, Milosevic Z, Schmidt A, Scheinert D, Schofer J, Sievert H, Sedgewick G, Saylors E, Sachar R, Cremonesi A, Micari A. PERFORMANCE 1 study: Novel carotid stent system with integrated post-dilation balloon and embolic protection device. Catheter Cardiovasc Interv 2022; 100:1090-1099. [PMID: 36229946 PMCID: PMC10092178 DOI: 10.1002/ccd.30410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/13/2022] [Accepted: 09/06/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The PERFORMANCE I study was designed to evaluate the safety and feasibility of the Neuroguard IEP® System, a novel carotid stent system with an integrated embolic filter and post-dilatation balloon, to treat clinically significant carotid artery stenosis. BACKGROUND The risk of major adverse events during carotid artery stenting is comparable to carotid endarterectomy, however, the risk of minor stroke remains higher with stenting. METHODS In total, 67 patients undergoing carotid artery stenting were enrolled at nine centers in Europe. Follow-up assessments included neurological exams, duplex ultrasound, 12-lead electrocardiogram, and cardiac enzyme analysis. The primary endpoint was the 30-day composite rate of stroke, death, and myocardial infarctions versus a prespecified performance goal. Secondary endpoints included procedure success, device success, and target lesion revascularization. RESULTS The study population was predominantly male (74.6%) with a mean age of 69.3 ± 8.9 years and 67% of subjects met at least one criterion placing them at an elevated risk for adverse events following carotid endarterectomy. All patients were treated successfully with the study device. There were no deaths or strokes within 30 days of the index procedure. One subject (1.5%) experienced a non-ST elevation myocardial infarction at day 17. The primary endpoint was met with a 30-day major adverse events rate of 1.5% (1/67). Through 12-month follow-up, there were no strokes, neurological deaths, target lesion revascularizations, or instances of in-stent-restenosis. CONCLUSIONS Results from this study demonstrate the Neuroguard IEP system is safe and feasible with a stroke/death rate of 0% at 30 days. A large pivotal study is currently underway.
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Affiliation(s)
- Ralf Langhoff
- Department for Angiology, Brandenburg Medical School Theodor Fontane, Campus Clinic Brandenburg, Center for Internal Medicine I, Berlin, Germany.,Department of Angiology, Sankt-Gertrauden-Krankenhaus, Berlin, Germany
| | - Ivo Petrov
- Cardiology and Angiology Department at Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria
| | - Sasko Kedev
- University Clinic of Cardiology Medical Faculty University "Ss. Cyril and Methodius" Skopje, Skopje, Macedonia
| | - Zoran Milosevic
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andrej Schmidt
- Clinic for Angiology, University Hospital Leipzig, Leipzig, Germany
| | - Dierk Scheinert
- Clinic for Angiology, University Hospital Leipzig, Leipzig, Germany
| | | | - Horst Sievert
- CardioVascular Center Frankfurt (CVC), Frankfurt, Germany
| | | | | | - Ravish Sachar
- Contego Medical, Inc, Raleigh, North Carolina, USA.,UNC-Rex Healthcare, Raleigh, North Carolina, USA
| | | | - Antonio Micari
- Department of Cardiology, University of Messina, Messina, Italy
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Mazurek A, Malinowski K, Rosenfield K, Capoccia L, Speziale F, de Donato G, Setacci C, Wissgott C, Sirignano P, Tekieli L, Karpenko A, Kuczmik W, Stabile E, Metzger DC, Amor M, Siddiqui AH, Micari A, Pieniążek P, Cremonesi A, Schofer J, Schmidt A, Musialek P. Clinical Outcomes of Second- versus First-Generation Carotid Stents: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11164819. [PMID: 36013058 PMCID: PMC9409706 DOI: 10.3390/jcm11164819] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/20/2022] [Accepted: 07/29/2022] [Indexed: 01/10/2023] Open
Abstract
Background: Single-cohort studies suggest that second-generation stents (SGS; “mesh stents”) may improve carotid artery stenting (CAS) outcomes by limiting peri- and postprocedural cerebral embolism. SGS differ in the stent frame construction, mesh material, and design, as well as in mesh-to-frame position (inside/outside). Objectives: To compare clinical outcomes of SGS in relation to first-generation stents (FGSs; single-layer) in CAS. Methods: We performed a systematic review and meta-analysis of clinical studies with FGSs and SGS (PRISMA methodology, 3302 records). Endpoints were 30-day death, stroke, myocardial infarction (DSM), and 12-month ipsilateral stroke (IS) and restenosis (ISR). A random-effect model was applied. Results: Data of 68,422 patients from 112 eligible studies (68.2% men, 44.9% symptomatic) were meta-analyzed. Thirty-day DSM was 1.30% vs. 4.11% (p < 0.01, data for SGS vs. FGS). Among SGS, both Casper/Roadsaver and CGuard reduced 30-day DSM (by 2.78 and 3.03 absolute percent, p = 0.02 and p < 0.001), whereas the Gore stent was neutral. SGSs significantly improved outcomes compared with closed-cell FGS (30-day stroke 0.6% vs. 2.32%, p = 0.014; DSM 1.3% vs. 3.15%, p < 0.01). At 12 months, in relation to FGS, Casper/Roadsaver reduced IS (−3.25%, p < 0.05) but increased ISR (+3.19%, p = 0.04), CGuard showed a reduction in both IS and ISR (−3.13%, −3.63%; p = 0.01, p < 0.01), whereas the Gore stent was neutral. Conclusions: Pooled SGS use was associated with improved short- and long-term clinical results of CAS. Individual SGS types, however, differed significantly in their outcomes, indicating a lack of a “mesh stent” class effect. Findings from this meta-analysis may provide clinically relevant information in anticipation of large-scale randomized trials.
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Affiliation(s)
- Adam Mazurek
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University, 31-202 Krakow, Poland
- Correspondence: (A.M.); (P.M.)
| | - Krzysztof Malinowski
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Kenneth Rosenfield
- Vascular Surgery, Surgery Department, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Laura Capoccia
- Vascular and Endovascular Surgery Unit, Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Unit, Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Carlo Setacci
- Department of Vascular Surgery, University of Siena, 53100 Siena, Italy
| | - Christian Wissgott
- Institut für Diagnostische und Interventionelle Radiologie/Neuroradiologie, Imland Klinik Rendsburg, 24768 Rendsburg, Germany
| | - Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy
| | - Lukasz Tekieli
- Department of Interventional Cardiology, John Paul II Hospital, Jagiellonian University, 31-202 Krakow, Poland
| | - Andrey Karpenko
- Centre of Vascular and Hybrid Surgery, E.N. Meshalkin National Medical Research Center, 630055 Novosibirsk, Russia
| | - Waclaw Kuczmik
- Department of General, Vascular Surgery, Angiology and Phlebology, Medical University of Silesia, 40-055 Katowice, Poland
| | | | | | - Max Amor
- Department of Interventional Cardiology, U.C.C.I. Polyclinique d’Essey, 54270 Nancy, France
| | - Adnan H. Siddiqui
- Department of Neurosurgery, SUNY University at Buffalo, Buffalo, NY 14203, USA
| | - Antonio Micari
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Piotr Pieniążek
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University, 31-202 Krakow, Poland
- Department of Interventional Cardiology, John Paul II Hospital, Jagiellonian University, 31-202 Krakow, Poland
| | - Alberto Cremonesi
- Cardiovascular Department, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy
| | - Joachim Schofer
- MVZ-Department Structural Heart Disease, Asklepios Clinic St. Georg, 20099 Hamburg, Germany
| | - Andrej Schmidt
- Department of Angiology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Piotr Musialek
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University, 31-202 Krakow, Poland
- Correspondence: (A.M.); (P.M.)
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Sýkora J, Zeleňák K, Vorčák M, Števík M, Sýkorová M, Sivák J, Rovňák M, Zapletalová J, Mužík J, Šinák I, Kurča E, Meyer L, Fiehler J. Comparison of Restenosis Risk in Single-Layer versus Dual-Layer Carotid Stents: A Duplex Ultrasound Evaluation. Cardiovasc Intervent Radiol 2022; 45:1257-1266. [PMID: 35798859 DOI: 10.1007/s00270-022-03200-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/04/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE The aim of this study was to report intermediate-term results of duplex ultrasound follow-up of carotid artery stenting performed with the dual-layer stent as compared to concurrent patients treated with other commercially available single-layer carotid stents. MATERIALS AND METHODS A single centre, retrospective, nonrandomized study including 162 non-consecutive patients with 199 implanted carotid stents treated over a 7-year period was conducted. Patients with at least one ultrasound examination after treatment were included. Procedural and follow-up data for patients treated with the dual-layer stent implantation (83 stents) vs first-generation carotid stents implantations (116 stents) were compared. RESULTS The median follow-up time was 24.0 months (IQR 10-32 months) for dual-layer stents and 27.5 months (IQR 10.3-59 months) for single-layer stents. The rate of severe restenosis was significantly higher in the dual-layer stent group than in the single-layer group (13.3% [11/83] vs 3.4% [4/116], p = 0.01). Seven reinterventions were performed in 5 patients with dual-layer stents. The rate of reintervention was significantly higher compared to no reinterventions in single-layer stents (6% [5/83] vs 0% [0/116], p = 0.012). Patients with restenosis had significantly higher presence of dyslipidaemia (100% [12/12] vs 63.3% [95/150], p = 0.009). CONCLUSIONS In this real-world cohort of patients undergoing carotid artery stenting, the patients treated with low-profile dual-layer micromesh stent showed higher rates of restenosis and reinterventions compared to first-generation single-layer stents.
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Affiliation(s)
- Ján Sýkora
- Clinic of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Kollárova 2, 036 59, Martin, Slovakia.,Department of Radiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, I. P. Pavlova 185/6, 77520, Olomouc, Czech Republic
| | - Kamil Zeleňák
- Clinic of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Kollárova 2, 036 59, Martin, Slovakia.
| | - Martin Vorčák
- Clinic of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Kollárova 2, 036 59, Martin, Slovakia
| | - Martin Števík
- Clinic of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Kollárova 2, 036 59, Martin, Slovakia
| | - Martina Sýkorová
- Vaša Ambulancia, s. r. o., Prieložtek 1, 036 01, Martin, Slovakia
| | - Jozef Sivák
- Department of Radiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, I. P. Pavlova 185/6, 77520, Olomouc, Czech Republic.,Middle-Slovak Institute of Cardiovascular Diseases, Cesta k nemocnici 1, 974 01, Banská Bystrica, Slovakia
| | - Marek Rovňák
- Orthopedic Clinic, Comenius University's Jessenius Faculty of Medicine and University Hospital, Kollárova 2, 036 59, Martin, Slovakia
| | - Jana Zapletalová
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacký University Olomouc, Hněvotínská 976/3, 775 15, Olomouc, Czech Republic
| | - Juraj Mužík
- Department of Geotechnics, Faculty of Civil Engineering, University of Žilina, Univerzitná, 8215/1, 010 26, Žilina, Slovakia
| | - Igor Šinák
- Department of Vascular Surgery, University Hospital, Kollárova 2, 036 59, Martin, Slovakia
| | - Egon Kurča
- Clinic of Neurology, University Hospital, Kollárova 2, 036 59, Martin, Slovakia
| | - Lukas Meyer
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Jens Fiehler
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
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Kiyosawa R, Saito T, Yamada S, Harada K. Efficacy of Post-Dilatation during Carotid Artery Stenting for Unstable Plaque Using a Double-Layer Stent Evaluated by OFDI. JOURNAL OF NEUROENDOVASCULAR THERAPY 2022; 16:395-401. [PMID: 37502638 PMCID: PMC10370631 DOI: 10.5797/jnet.oa.2022-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/22/2022] [Indexed: 07/29/2023]
Abstract
Objective This study aimed to use optical frequency domain imaging (OFDI) to evaluate the efficacy of post-dilatation (PD) after stent placement for unstable plaques during carotid artery stenting (CAS) using a double-layer stent. Methods Twelve unstable carotid plaque lesions diagnosed by MRI were evaluated using OFDI during CAS. The pre-procedural minimum lumen diameter was 1.6 ± 0.7 mm. Each lesion was pre-dilated with balloon catheters (diameter, 5.3 ± 0.5 mm), and a double-layer stent was deployed. PD was performed with balloon catheters of the same size as those used for pre-dilatation. Cross-sectional OFDI images within the stented segment were evaluated at 1-mm intervals for a 20-mm segment, including the most stenotic lesion. Slice rates for the presence of in-stent plaque protrusion (PP) and plaque between the double-layer lumen were calculated. Results No procedural complications occurred with the use of an embolic protection device. Compared to after stent placement, slice rates for any PP (44 ± 19% to 62 ± 22%, P <0.05) and plaque between the double-layer lumen (79 ± 16% to 91 ± 34%, P <0.05) were significantly increased after PD; slice rates for >500 μm PP (7.5 ± 14% to 0%, P <0.05) were significantly decreased. Visible debris were captured in 50% of lesions. Conclusion PD after double-layer carotid stent placement decreases in-stent large PP. Double-layer construction contributed to the prevention of large PP, as the PP may have been crushed into debris by PD.
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Affiliation(s)
- Ryuichiro Kiyosawa
- Department of Neurosurgery, Fukuoka Wajiro Hospital, Fukuoka, Fukuoka, Japan
| | - Takaya Saito
- Department of Neurosurgery, Fukuoka Wajiro Hospital, Fukuoka, Fukuoka, Japan
| | - Shingo Yamada
- Department of Neurosurgery, Fukuoka Wajiro Hospital, Fukuoka, Fukuoka, Japan
| | - Kei Harada
- Department of Neurosurgery, Fukuoka Wajiro Hospital, Fukuoka, Fukuoka, Japan
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Mazzaccaro D, Giannetta M, Fancoli F, Righini P, Nano G. Endovascular treatment of extracranial carotid artery stenosis using a dual-layer micromesh stents: a systematic review. Expert Rev Med Devices 2021; 18:545-552. [PMID: 33966558 DOI: 10.1080/17434440.2021.1927707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: We aimed to review the safety and effectiveness of dual-layer micromesh stents for the endovascular treatment of carotid artery stenosis.Methods: Electronic bibliographic databases were searched using the words 'micromesh carotid stent'. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards.Results: The search of the Literature retrieved 84 results. After assessment of full texts, 13 papers were included in the study. The analyzed studies included 797 patients, 32.1% of them were symptomatic. The reported technical success rate was 100% in all cases. During early follow-up, complications occurred overall in 16/797 patients (2%: 12 strokes, 3 deaths, and one transient ischemic attack). The study with the longest follow-up reported a survival rate of 82% at 4 years and a stroke-free survival rate of 84% at 4 years.Conclusion: With the limit of low data quality, the use of dual-layer stents was reported to be as safe and effective at 30 days for the endovascular treatment of extracranial carotid artery stenosis. The reported technical success was 100% in all cases. Further data coming from randomized controlled trials and larger cohort studies with longer follow-up are nevertheless needed for a better evaluation.
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Affiliation(s)
- Daniela Mazzaccaro
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Matteo Giannetta
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Fabiana Fancoli
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paolo Righini
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Nano
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Kahlberg A, Bilman V, Ardita V, Mascia D, Bertoglio L, Rinaldi E, Melissano G, Chiesa R. Contemporary Results of Carotid Artery Stenting Using Low-Profile Dual-Metal Layer Nitinol Micromesh Stents in Relation to Single-Layer Carotid Stents. J Endovasc Ther 2021; 28:726-736. [PMID: 34137659 DOI: 10.1177/15266028211025046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate patients characteristics, procedural details, perioperative outcomes, and midterm results of carotid artery stenting (CAS) performed with the Roadsaver/Casper stent (Terumo Corp, Tokyo, Japan) as compared to concurrent patients treated with other commercially available carotid stents. MATERIALS AND METHODS This is a single-center, retrospective, nonrandomized study including 200 consecutive patients who underwent a total of 205 elective CAS procedures due to severe internal carotid artery stenosis between April 2015 and December 2018. Procedural data and outcomes for patients treated with the Roadsaver/Casper stent implantation (100 procedures, in 97 patients) vs first-generation carotid stents implantations (90 procedures, in 88 patients) were compared. Fifteen patients were treated with CGuard carotid stent (InspireMD, Tel Aviv, Israel), and outcomes were reported separately. Primary endpoints were the occurrence of major adverse cerebrovascular events (MACE), including death, ipsilateral stroke, and transitory ischemic attack (TIA). Secondary endpoints were the rate of intrastent stenosis, the need for reintervention, and the occurrence of adverse cardiovascular events, including myocardial infarction, arrhythmias, and need for inotropic support. RESULTS No difference in demographics and preoperative risk factors were observed between patients treated with and without the Roadsaver/Casper stent. The mean procedure time was shorter in the Roadsaver/Casper group (40.7±16.9 vs 49.4±27.3 minutes; p=0.008), while radial percutaneous access was more frequent (24% vs 5%; p<0.001). The rate of stroke/TIA/death at 30 days was 3% in the Roadsaver group vs 1% in the first-generation stent group (p=0.623). The primary patencyrate was 100% and 93.4% at 1- and 3-year of follow-up in the Roadsaver/Casper groupand 99% and 94.3% in the other stent group, respectively (p=0.95). CONCLUSIONS In this real-world cohort of patients undergoing CAS, the Roadsaver/Casper stent was used to treat more symptomatic and vulnerable carotid plaques as compared to other carotid stents. Nevertheless, patients treated with this low-profile dual-layer micromesh stent showed low events rates at both 30 days and follow-up, similar to that observed for other stents.
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Affiliation(s)
- Andrea Kahlberg
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Victor Bilman
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Ardita
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Mascia
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Bertoglio
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Rinaldi
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Germano Melissano
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Chiesa
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
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11
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Tigkiropoulos K, Papoutsis I, Abatzis-Papadopoulos M, Kousidis P, Mpismpos D, Melas N, Stavridis K, Karamanos D, Lazaridis I, Saratzis N. Thirty-Day Results of the Novel CGuard-Covered Stent in Patients Undergoing Carotid Artery Stenting. J Endovasc Ther 2021; 28:542-548. [PMID: 33855877 DOI: 10.1177/15266028211007466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to provide early-term evaluation, safety, and efficacy of the novel CGuard (Inspire MD, Tel Aviv, Israel) micromesh self-expanding stent with embolic protection system (EPS) during carotid artery stenting (CAS) procedure. MATERIALS AND METHODS All patients who underwent CAS with CGuard carotid stent system from January 2018 to September 2020 in a tertiary center were prospectively evaluated. Primary endpoints included technical success and perioperative neurological events (0-48 hours). Secondary endpoint was the rate of neurologic, cardiac events, and death (major adverse event or MAE) at 30 days. Patency of CGuard, peak systolic velocity (PSV), and end diastolic velocity (EDV) were evaluated at 30 days with duplex ultrasound. RESULTS A total of 103 patients underwent CAS procedure. Forty patients were symptomatic, and 63 patients were asymptomatic with stenosis greater than 70%. Technical success was 100%. Local anesthesia was applied in 94 patients (93%). Embolic protection devices were used in 6 patients (5.8%). Access site complications were 1.9%. Mean internal carotid artery stenosis diameter reduced from 79.47% to 14.68%. Two patients had transient ischemic attack (1.9%) and 1 patient experienced a cerebral hyperperfusion syndrome (CHS) perioperatively. External carotid artery (ECA) occlusion occurred in 1.9%. Four patients experienced jaw claudication (3.8%) postoperatively. Mean time of operation was 41 minutes. Mean duration of hospitalization was 3.1 days. The 30-day rate of MAE was 0%. CGuard patency was 100%, mean internal carotid PSV was reduced from 251.57 to 77.29 cm/s, and mean internal carotid EDV was reduced from 154.62 to 24.63 cm/s at 30 days. CONCLUSION Our study shows that CGuard stent with EPS is an effective and safe device for treatment of carotid artery stenosis with acceptable low perioperative neurologic events, even with low embolic protection device usage. Larger multicenter and randomized studies are necessary to confirm its long-term efficacy.
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Affiliation(s)
- Konstantinos Tigkiropoulos
- Vascular Unit, 1st University Surgical Department, Aristotle University, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Ioakeim Papoutsis
- Vascular Unit, 1st University Surgical Department, Aristotle University, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Manolis Abatzis-Papadopoulos
- Vascular Unit, 1st University Surgical Department, Aristotle University, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Panagiotis Kousidis
- Vascular Unit, 1st University Surgical Department, Aristotle University, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Dimitrios Mpismpos
- Vascular Unit, 1st University Surgical Department, Aristotle University, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Nikolaos Melas
- Vascular Unit, 1st University Surgical Department, Aristotle University, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Kyriakos Stavridis
- Vascular Unit, 1st University Surgical Department, Aristotle University, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Dimitrios Karamanos
- Vascular Unit, 1st University Surgical Department, Aristotle University, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Ioannis Lazaridis
- Vascular Unit, 1st University Surgical Department, Aristotle University, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Nikolaos Saratzis
- Vascular Unit, 1st University Surgical Department, Aristotle University, General Hospital Papageorgiou, Thessaloniki, Greece
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12
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Carvalho P, Coelho A, Mansilha A. Effectiveness and safety of dual-layer stents in carotid artery disease: a systematic review. INT ANGIOL 2020; 40:97-104. [PMID: 33337115 DOI: 10.23736/s0392-9590.20.04553-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Carotid artery stenting (CAS) has emerged as a minimally invasive alternative to carotid endarterectomy (CEA) in atherosclerotic carotid artery disease, even though the risk for procedural stroke after CAS remains significantly higher. Recently, in order to reduce embolic cerebral events after CAS, a new generation of dual-layer stents (DLS) has been developed. This review aimed to perform a detailed analysis of the available evidence on safety and efficacy of DLS in both symptomatic and asymptomatic atherosclerotic carotid artery stenosis. EVIDENCE ACQUISITION A systematic review was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The primary endpoint was the 30-day rate of myocardial infarction (MI), stroke and death. Secondary outcomes included rate and timing of stent occlusion/restenosis. EVIDENCE SYNTHESIS A total of 20 articles with 1193 patients were included. Thirty-day MI ranged from 0-5%, 30-day stroke ranged from 0-10.5% and 30-day mortality ranged from 0-10%. Stent occlusion rate ranged from 0-52.4%, the majority of which occurred intraprocedurally (N.=50; 61.7%), in emergency treated patients. The incidence of new ipsilateral cerebral ischemic lesions after CAS with DLS was reported in five studies, ranging from 5.5-37%. CONCLUSIONS Despite the theoretic advantage of reducing the risk for procedural embolic events when compared to conventional stents, high quality evidence is scarce. Also, safety issues regarding DLS in the emergency setting have been raised, particularly for thrombotic complications. Additional data from well-designed Randomized Controlled Trials are needed to assert the true value of DLS.
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Affiliation(s)
| | - Andreia Coelho
- Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Angiology and Vascular Surgery, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Armando Mansilha
- Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Angiology and Vascular Surgery, University Hospital Center of São João, Porto, Portugal
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Machnik RA, Pieniążek P, Misztal M, Plens K, Kazibudzki M, Tomaszewski T, Brzychczy A, Musiał R, Trystuła M, Tekieli ŁM. Carotid artery stenting with Roadsaver stent. Early and four-year results from a single-center registry. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:444-451. [PMID: 33598018 PMCID: PMC7863817 DOI: 10.5114/aic.2020.101770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/19/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Prevention of peri- and postprocedural complications is still a challenge in carotid artery stenting (CAS). AIM To assess immediate and long-term safety and effectiveness of CAS using the Roadsaver double-nitinol-layer-micromesh stent. MATERIAL AND METHODS Since 2014, 298 CAS procedures in 287 non-consecutive patients (203 men, mean age 70.5 ±8.6 years, 100% symptomatic/high risk lesions) have been performed using the Roadsaver stent and proximal (40%) or distal (60%) neuroprotection system. Clinical and neurological examinations as well as duplex ultrasound were completed before CAS, before discharge, at 1, 6 and 12 months, then annually. RESULTS All CAS procedures were successful. Carotid stenosis was reduced from 84.9 ±9.9% to 11.0 ±9.4% (p < 000.1). In hospital, 1 ipsilateral periprocedural major (0.3%) and 3 minor (1.34%) ischemic strokes occurred, 2 (0.7%) patients died due to a cerebral hemorrhage on day 9 and 21. Three (1.0%) additional ipsilateral minor strokes within 30 consecutive days occurred. Thus, 30-day complications were observed in 9 (3.0%) patients. Two minor strokes were associated with in-stent thrombosis (0.7%). The 4-year follow-up showed 82% overall survival (95% CI: 69-91%) with no significant difference between asymptomatic (77%) and symptomatic patients (97%; p = 0.076). The stroke-free survival was 89% (95% CI: 77-95%), 84% asymptomatic vs. 98% symptomatic (p = 0.187). Seven (2.3%) patients developed > 50% in-stent restenosis. CONCLUSIONS Carotid artery stenting using the Roadsaver stent for symptomatic patients and high risk lesions showed to be safe and effective, with a low complication rate and acceptable in-stent restenosis risk in 4-year follow-up.
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Affiliation(s)
- Roman A. Machnik
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
| | - Piotr Pieniążek
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, John Paul II Hospital, Krakow, Poland
| | - Marcin Misztal
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
| | | | - Marek Kazibudzki
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
| | | | - Andrzej Brzychczy
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
| | - Robert Musiał
- Department of Anesthesiology and Intensive Medical Therapy, John Paul II Hospital, Krakow, Poland
| | - Mariusz Trystuła
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
| | - Łukasz M. Tekieli
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, John Paul II Hospital, Krakow, Poland
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14
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Imamura H, Sakai N, Matsumoto Y, Yamagami H, Terada T, Fujinaka T, Yoshimura S, Sugiu K, Ishii A, Matsumaru Y, Izumi T, Oishi H, Higashi T, Iihara K, Kuwayama N, Ito Y, Nakamura M, Hyodo A, Ogasawara K. Clinical trial of carotid artery stenting using dual-layer CASPER stent for carotid endarterectomy in patients at high and normal risk in the Japanese population. J Neurointerv Surg 2020; 13:524-529. [PMID: 32934139 PMCID: PMC8142440 DOI: 10.1136/neurintsurg-2020-016250] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/27/2020] [Accepted: 08/30/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The dual-layer nitinol CASPER stent was designed to prevent plaque prolapse into its strut and periprocedural stroke. OBJECTIVE To conduct a clinical trial for government approval of the device in patients at either high or normal risk for carotid endarterectomy (CEA). METHODS Eligible patients had ≥50% symptomatic stenosis or ≥80% asymptomatic stenosis according to the North American Symptomatic Carotid Endarterectomy Trial methods (peak systolic velocity 130 and 230 cm/s on ultrasonography, respectively). The primary endpoint was the lack of major adverse events (MAEs), defined as death, stroke, and myocardial infarction within 30 days, and ipsilateral stroke within 1 year. The performance goal was set at 90.5%. MAE rates were also compared between the CEA high- and normal-risk groups. RESULTS 140 carotid artery stenting procedures, including 40% of patients at high risk and 60% at normal risk for CEA, were performed in 13 institutes. MAEs occurred in two cases (one intraprocedural and one postprocedural stroke), and the MAE rate was 1.4%. The non-MAE rate was 98.6% according to Kaplan-Meier analysis, which was superior to the previously set performance goal. The deployment success, target lesion revascularization (TLR), in-stent restenosis, and cerebrovascular event rates were 99.3%, 2.4%, 8.5%, and 7.2%, respectively. The MAE rate in patients with normal CEA risk was 1.2%, which was similar to the high-risk CEA group, with no significant difference due to the small number of MAEs. CONCLUSIONS The MAE rate following use of the CASPER stent was low (1.4%). The MAE, deployment success, TLR, in-stenosis, and cerebrovascular event rates were similar to those of previous reports.
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Affiliation(s)
- Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yasushi Matsumoto
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
| | - Hiroshi Yamagami
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomoaki Terada
- Department of Neurosurgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Toshiyuki Fujinaka
- Department of Neurosurgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kenji Sugiu
- Department of Neurosurgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Akira Ishii
- Department of Neurosugery, Kyoto University, Kyoto, Japan
| | - Yuji Matsumaru
- Division of Stroke prevention and treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidenori Oishi
- Department of Neurosurgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Toshio Higashi
- Department of Neurosurgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Koji Iihara
- Department of Neurosurgery, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Naoya Kuwayama
- Department of Neurosurgery, University of Toyama, Toyama, Japan
| | - Yasushi Ito
- Department of Neurosurgery, Shinrakuen Hospital, Niigata, Japan
| | | | - Akio Hyodo
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
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15
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Kuwahara S, Matsukawa H, Yamada K, Uchida K, Shirakawa M, Yoshimura S. A Patient with Carotid Mobile Plaques Treated by Carotid Artery Stenting Using a Double-layer Micromesh Stent. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:495-500. [PMID: 37501767 PMCID: PMC10370942 DOI: 10.5797/jnet.cr.2019-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/08/2020] [Indexed: 07/29/2023]
Abstract
Objective We report a case of carotid mobile plaques treated by carotid artery stenting (CAS) using a double-layer micromesh stent (CASPER stent). Case Presentation An 86-year-old male presented with lightheadedness. Carotid artery ultrasound revealed mobile plaques in the right internal carotid artery (ICA). Head and neck MRI demonstrated concomitant left ICA occlusion. We first started medical treatment, but it could not reduce the plaque size. Then, we performed CAS using a CASPER stent in addition to medical treatment. The procedure was finished without complications, and there was no plaque protrusion. The postoperative course was uneventful during 3 years of follow-up. Conclusion A mobile plaque of the carotid artery may be treated less-invasively with a micromesh stent.
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Affiliation(s)
- Shuntaro Kuwahara
- Department of Neurosurgery, Goshi Hospital, Amagasaki, Hyogo, Japan
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hidetoshi Matsukawa
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kiyofumi Yamada
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Manabu Shirakawa
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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16
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Sirignano P, Stabile E, Mansour W, Capoccia L, Faccenna F, Intrieri F, Ferri M, Saccà S, Sponza M, Mortola P, Ronchey S, Grillo P, Chiappa R, Losa S, Setacci F, Pirrelli S, Taurino M, Ruffino MA, Udini M, Palombo D, Ippoliti A, Montelione N, Setacci C, de Donato G, Ruggeri M, Speziale F. 1-Month Results From a Prospective Experience on CAS Using CGuard Stent System. JACC Cardiovasc Interv 2020; 13:2170-2177. [DOI: 10.1016/j.jcin.2020.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/26/2022]
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18
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Yamada K, Yoshimura S, Yoshida K, Uchida K, Shirakawa M, Kawasaki M, Miura M, Ishii A, Kataoka H, Miyamoto S. Carotid Artery Stenting Using a Double-layer Micromesh Stent. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:407-412. [PMID: 37502654 PMCID: PMC10370536 DOI: 10.5797/jnet.ra.2020-0066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/10/2020] [Indexed: 07/29/2023]
Abstract
Carotid artery stenting (CAS) has recently emerged as a potential alternative to carotid endarterectomy (CEA) in Japan. However, one of its disadvantages is the higher incidence of ischemic complications than CEA, such as distal embolism during or after the procedure. Plaque protrusion (PP) through the stent strut after deployment of the stent has been suggested as one of the major causes of distal embolism, especially in patients with unstable plaques. The need for increased plaque coverage to reduce the risk of PP through the stent struts has led to the development of a double-layer micromesh stent (micromesh stent) system. This stent system has already been used clinically in European countries with good short- to medium-term follow-up results. Also clinical trials evaluating micromesh stents have been completed in Japan. Hence, usefulness of the micromesh stent for CAS is expected. According to the results of several clinical studies, CAS with the double-layer micromesh stent has the potential to minimize distal embolism during or after the procedure even in patients with unstable plaques. However, it may not be suitable for emergency CAS at this point. Also, since results of only short- to medium-term follow-up have been reported, longer-term follow-up will be required in the near future.
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Affiliation(s)
- Kiyofumi Yamada
- Department of Neurosurgery, Kyoto University, Kyoto, Kyoto, Japan
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | | | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Manabu Shirakawa
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | | | - Masatomo Miura
- Department of Neurology, Kumamoto Red Cross Hospital, Kumamoto, Kumamoto, Japan
| | - Akira Ishii
- Department of Neurosurgery, Kyoto University, Kyoto, Kyoto, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, Kyoto University, Kyoto, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University, Kyoto, Kyoto, Japan
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19
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Gruber P, Berberat J, Kahles T, Anon J, Diepers M, Nedeltchev K, Remonda L. Comparison of different carotid stent designs in endovascular therapy of severe carotid artery stenosis. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2020. [DOI: 10.1177/2514183x20932417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: One of the major periprocedural risks of carotid artery stenting is embolism caused either by plaque debris or by local thrombus forming. Double-layer micromesh stent design has shown to lower the chance of debris embolism but might have a slightly higher risk of local thrombus forming. Thus, we compared two different stent designs regarding safety and outcome profile in elective patients with high-grade carotid artery stenosis using a self-expanding, double-layer micromesh carotid stent system (DLCS) or a self-expanding hybrid carotid stent system (HCS). Methods: A single-center, open-label, retrospective cohort study of 67 consecutive, elective patients with high-grade symptomatic and asymptomatic carotid stenosis was executed at a comprehensive stroke center. Outcome measures were reocclusion rate, periprocedural symptomatic ischemic events, as well as other periprocedural complications, and recurrent stroke and mortality at 30 days’ follow-up. Results: Thirty-two patients (24% women, median age 75 years (interquartile range (IQR) 71–80) were treated with DLCS, and 35 patients (29% women, median age 71 years (IQR 63–76) years) with HCS. In both groups, pretreatment carotid stenosis degree was similar (median NASCET of 80%). Successful deployment was achieved in all cases without technical failure, and both groups did not differ in reocclusion rates, recurrent stroke, and mortality within 30 days. Conclusions: DCLS and HCS revealed to have similar safety and outcome profile in elective patients with high-grade symptomatic as well as asymptomatic carotid artery stenosis.
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Affiliation(s)
- Philipp Gruber
- Department of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Jatta Berberat
- Department of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Timo Kahles
- Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland
| | - Javier Anon
- Department of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Michael Diepers
- Department of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Krassen Nedeltchev
- Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland
- University Berne, Berne, Switzerland
| | - Luca Remonda
- Department of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
- University Berne, Berne, Switzerland
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20
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Myouchin K, Takayama K, Wada T, Miyasaka T, Tanaka T, Kotsugi M, Kurokawa S, Nakagawa H, Kichikawa K. Carotid Artery Stenting Using a Closed-Cell Stent-in-Stent Technique for Unstable Plaque. J Endovasc Ther 2019; 26:565-571. [PMID: 31074315 DOI: 10.1177/1526602819847698] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To examine whether carotid artery stenting (CAS) of stenoses with unstable plaque using a closed-cell stent-in-stent technique prevents plaque protrusion. Materials and Methods: Between December 2014 and August 2018, 35 consecutive patients (mean age 75.8 years; 29 men) with carotid artery stenosis (20 symptomatic) and unstable plaque diagnosed by magnetic resonance imaging were prospectively analyzed. Mean diameter stenosis was 83.5%. All CAS procedures were performed with stent-in-stent placement of Carotid Wallstents using an embolic protection device and conservative postdilation. The technical success rate, incidence of plaque protrusion, ischemic stroke rate within 30 days, and new ipsilateral ischemic lesions on diffusion-weighted imaging (DWI) within 48 hours after CAS were prospectively assessed. Follow-up outcomes included the incidences of ipsilateral stroke and restenosis. Results: The technical success rate was 100%. No plaque protrusion or stroke occurred in any patient. New ischemic lesions were observed on DWI in 10 (29%) patients. During the mean 11.6-month follow-up, no ipsilateral strokes occurred. Two (6%) patients developed asymptomatic restenosis recorded as 53% lumen narrowing and occlusion, respectively. Conclusion: CAS using a closed-cell stent-in-stent technique for unstable plaque may be useful for preventing plaque protrusion and ischemic complications.
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Affiliation(s)
- Kaoru Myouchin
- 1 Department of Radiology and Interventional Neuroradiology, Ishinkai Yao General Hospital, Yao, Japan
| | - Katsutoshi Takayama
- 1 Department of Radiology and Interventional Neuroradiology, Ishinkai Yao General Hospital, Yao, Japan
| | - Takeshi Wada
- 2 Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Japan
| | - Toshiteru Miyasaka
- 2 Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Japan
| | - Toshihiro Tanaka
- 2 Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Japan
| | - Masashi Kotsugi
- 3 Department of Neurosurgery, Ishinkai Yao General Hospital, Yao, Japan
| | | | - Hiroyuki Nakagawa
- 2 Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Japan
| | - Kimihiko Kichikawa
- 2 Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Japan
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Speziale F, Capoccia L, Sirignano P, Mansour W, Pranteda C, Casana R, Setacci C, Accrocca F, Alberti D, de Donato G, Ferri M, Gaggiano A, Galzerano G, Ippoliti A, Mangialardi N, Pratesi G, Ronchey S, Ruffino M, Siani A, Spinazzola A, Sponza M. Thirty-day results from prospective multi-specialty evaluation of carotid artery stenting using the CGuard MicroNet-covered Embolic Prevention System in real-world multicentre clinical practice: the IRON-Guard study. EUROINTERVENTION 2019; 13:1714-1720. [PMID: 28485278 DOI: 10.4244/eij-d-17-00008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of the present study was to evaluate periprocedural and 30-day outcomes in a prospective series of patients treated with the CGuard Embolic Prevention System (EPS). METHODS AND RESULTS From April 2015 to June 2016, a physician-initiated prospective multicentre study was performed in 200 consecutive patients admitted for protected carotid artery stenting (CAS) and treated using the CGuard EPS in twelve vascular centres. Outcome measures were: technical success, periprocedural (0-24 hours) and post-procedural (24 hours-30 days) major and minor strokes, death, acute myocardial infarction (AMI), transient ischaemic attack (TIA), and external carotid occlusion. In three centres, consecutive diffusion-weighted magnetic resonance cerebral imaging (DW-MRI) was performed ≤72 hours prior to and within 72 hours after the intervention. A distal embolic protection device was employed in 182 patients (91%). Technical success was 100%. No death, AMI or major stroke occurred periprocedurally. There were two TIAs and five periprocedural minor strokes (2.5%), including one thrombosis solved by surgery. In the remaining patients (199/200; 99.5%) one-month follow-up duplex ultrasound revealed optimal technical results. Post-procedural clinical follow-up was uneventful. No external carotid artery occlusion occurred. New post-procedural DW-MRI lesions were detected in 12 patients out of 61 (19.6%), including bilateral in five (8.2%) and isolated ipsilateral in six (9.8%), whereas one patient (1.6%) had contralateral only lesions. CONCLUSIONS Multicentre multi-specialty use of the CGuard EPS in routine clinical practice was associated with no major periprocedural neurologic complications and a total elimination of post-procedural neurologic complications by 30 days.
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Affiliation(s)
- Francesco Speziale
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
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Capoccia L, Sirignano P, Mansour W, d'Adamo A, Sbarigia E, Mariani P, Di Biasi C, Speziale F. Peri-procedural brain lesions prevention in CAS (3PCAS): Randomized trial comparing CGuard™ stent vs. Wallstent™. Int J Cardiol 2019; 279:148-153. [DOI: 10.1016/j.ijcard.2018.09.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/17/2018] [Accepted: 09/19/2018] [Indexed: 11/16/2022]
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Stabile E, de Donato G, Musialek P, De Loose K, Nerla R, Sirignano P, Chianese S, Mazurek A, Tesorio T, Bosiers M, Setacci C, Speziale F, Micari A, Esposito G. Use of Dual-Layered Stents in Endovascular Treatment of Extracranial Stenosis of the Internal Carotid Artery. JACC Cardiovasc Interv 2018; 11:2405-2411. [DOI: 10.1016/j.jcin.2018.06.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 06/06/2018] [Accepted: 06/26/2018] [Indexed: 12/24/2022]
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Nerla R, Micari A, Castriota F, Miccichè E, Ruffino MA, de Donato G, Setacci C, Cremonesi A. Carotid artery stenting with a new-generation double-mesh stent in three high-volume Italian centres: 12-month follow-up results. EUROINTERVENTION 2018; 14:1147-1149. [DOI: 10.4244/eij-d-18-00513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bosiers M, Deloose K, Torsello G, Scheinert D, Maene L, Peeters P, Müller-Hülsbeck S, Sievert H, Langhoff R, Callaert J, Setacci C, Wauters J. Evaluation of a new dual-layer micromesh stent system for the carotid artery: 12-month results from the CLEAR-ROAD study. EUROINTERVENTION 2018; 14:1144-1146. [DOI: 10.4244/eij-d-18-00230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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26
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De Carlo M, Mazzolai L, Bossone E, Brodmann M, Micari A, Muiesan ML, Ricco JB, Stabile E, Agnelli G, Aboyans V. The year in cardiology 2016: peripheral circulation. Eur Heart J 2018; 38:1028-1033. [PMID: 28043979 DOI: 10.1093/eurheartj/ehw643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 12/28/2016] [Indexed: 01/16/2023] Open
Affiliation(s)
- Marco De Carlo
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, via Paradisa 2, 56100 Pisa, Italy
| | - Lucia Mazzolai
- Department of Angiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Eduardo Bossone
- Cardiology Division, "Cava de' Tirreni and Amalfi Coast", Heart Department, University Hospital, Via Enrico de Marinis, 84013 Cava de' Tirreni (SA), Italy
| | - Marianne Brodmann
- Division of Angiology, Medical University Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Antonio Micari
- GVM Care and Research, Maria Cecilia Hospital, via Corriera 1, 48033 Cotignola (RA), Italy
| | - Maria Lorenza Muiesan
- Clinical and Experimental Sciences Department, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Jean-Baptiste Ricco
- Department of Vascular Surgery, University Hospital of Poitiers, 2 Rue de la Milétrie, 86021 Poitiers, France
| | - Eugenio Stabile
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Napoli "Federico II", Corso Umberto I 40, 80138 Napoli, Italy
| | - Giancarlo Agnelli
- Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Viale Zefferino Faina 4, 06123 Perugia, Italy
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, Limoges, and Inserm 1094, Tropical Neuroepidemiology, University of Limoges, 33 Rue François Mitterrand, 87032 Limoges, France
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Broussalis E, Griessenauer C, Mutzenbach S, Pikija S, Jansen H, Stevanovic V, Killer-Oberpfalzer M. Reduction of cerebral DWI lesion burden after carotid artery stenting using the CASPER stent system. J Neurointerv Surg 2018; 11:62-67. [PMID: 29930158 DOI: 10.1136/neurintsurg-2018-013869] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Despite various measures to protect against distal embolization during carotid artery stenting (CAS), periprocedural ischemic lesions are still encountered. OBJECTIVE To evaluate the periprocedural cerebral diffusion weighted imaging (DWI) lesion burden after CASPER stent placement. METHODS Patients who underwent CAS using the CASPER stent system were reviewed. Degrees of carotid stenosis and plaque configuration were determined. All patients were pretreated with dual antiplatelet agents and cerebral pre- and postprocedural MRI was obtained. All CAS procedures were performed by a single operator. RESULTS A total of 110 patients with severe carotid artery stenosis (median degree of stenosis 80%, median length of stenosis 10 mm) were treated with CAS. Hypoechogenic or heterogeneous, mostly hypoechogenic, plaques were documented in 48.6% (52/107) of patients. Carotid ulceration was present in 15.9% (17/107). Postprocedurally, 7.3% (8/110) of patients were found to have ischemic DWI lesions. They were asymptomatic in all patients. Follow-up at 90 days was available in 88.2% (97/110) of patients with excellent functional outcome (modified Rankin Scale score 0-1) in 95.9% (93/97). CONCLUSION Carotid artery stenting using the new CASPER stent in combination with a distal embolic protection device is safe and results in a lower rate of periprocedural DWI lesion burden compared with reported results for historic controls.
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Affiliation(s)
- Erasmia Broussalis
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.,Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Christoph Griessenauer
- Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.,Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Sebastian Mutzenbach
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Slaven Pikija
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Hendrik Jansen
- Department of Neuroradiology, Paracelsus Medical University, Nuremberg, Germany
| | - Valdo Stevanovic
- Department of Radiology/Section Neuroradiology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Monika Killer-Oberpfalzer
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.,Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
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Bosiers M, Deloose K, Callaert J, Wauters J. Impact of stent design on outcomes of carotid stent angioplasty. Semin Vasc Surg 2018; 31:4-8. [DOI: 10.1053/j.semvascsurg.2018.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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de Donato G, Setacci F, Pasqui E, Benevento D, Palasciano G, Sterpetti A, di Marzo L, Setacci C. Early carotid artery stenting after onset neurologic symptoms. Semin Vasc Surg 2018; 31:15-20. [PMID: 29891028 DOI: 10.1053/j.semvascsurg.2018.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Multicenter clinical trials level 1 evidence favors the application of carotid endarterectomy in symptomatic patients, especially the in the elderly cohort. Carotid artery stenting has been proposed as a possible early alternative in selected patients after onset of ipsilateral neurologic symptoms. It is well known that treatment of acute stroke is time-dependent in patients with acute ischemic stroke caused by high-grade stenosis of the internal carotid artery, but intensive medical treatment in conjunction with intervention to improve stroke severity and clinical outcomes has not been established. Two major clinical concerns exist: (1) the risk of hemorrhagic infarction after cerebral revascularization in the acute stage and (2) application of carotid stenting in the acute embolic stage, which may be associated with continued embolic risk after carotid artery stenting compared to carotid endarterectomy, which removes the symptomatic plaque. This review summarizes the indications and results of early carotid artery stenting after onset of neurologic symptoms, considering the new carotid stents and cerebral protection systems available for clinical use and enhanced stenting techniques.
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Affiliation(s)
- Gianmarco de Donato
- Department of Surgery, Unit of Vascular and Endovascular Surgery, University of Siena, Viale Bracci, 53100 Siena Siena, Italy.
| | - Francesco Setacci
- Department of Vascular Surgery, Casa di Cura Giovanni XXIII, Monastier di Treviso, Italy
| | - Edoardo Pasqui
- Department of Surgery, Unit of Vascular and Endovascular Surgery, University of Siena, Viale Bracci, 53100 Siena Siena, Italy
| | - Domenico Benevento
- Department of Surgery, Unit of Vascular and Endovascular Surgery, University of Siena, Viale Bracci, 53100 Siena Siena, Italy
| | - Giancarlo Palasciano
- Department of Surgery, Unit of Vascular and Endovascular Surgery, University of Siena, Viale Bracci, 53100 Siena Siena, Italy
| | - Antonio Sterpetti
- Department of Vascular Surgery, University Roma La Sapienza, Rome, Italy
| | - Luca di Marzo
- Department of Vascular Surgery, University Roma La Sapienza, Rome, Italy
| | - Carlo Setacci
- Department of Surgery, Unit of Vascular and Endovascular Surgery, University of Siena, Viale Bracci, 53100 Siena Siena, Italy
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Cremonesi A, Nerla R, Castriota F. Micro-mesh technology in routine CAS: the final piece of the puzzle? EUROINTERVENTION 2018; 13:1629-1630. [PMID: 29465406 DOI: 10.4244/eijv13i14a263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Alberto Cremonesi
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
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Mutzenbach SJ, Millesi K, Roesler C, Broussalis E, Pikija S, Sellner J, Machegger L, Griessenauer CJ, Killer-Oberpfalzer M. The Casper Stent System for carotid artery stenosis. J Neurointerv Surg 2018; 10:869-873. [DOI: 10.1136/neurintsurg-2017-013583] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/19/2017] [Accepted: 12/24/2017] [Indexed: 01/31/2023]
Abstract
PurposeTo report the results of a retrospective analysis of prospectively collected data evaluating the safety and efficacy of a double layer stent engineered for carotid artery occlusive disease.MethodsBetween January 2014 and February 2017, 138 patients (25.4% women; median age 71 years) underwent Casper stent implantation for carotid artery stenosis. Eligibility criteria included stenosis >70% of vessel diameter (or >50% diameter with ulceration) in symptomatic patients or asymptomatic patients with >80% stenosis at the carotid bifurcation or in the proximal internal carotid artery. For all procedures, a distal embolic protection device was used. The primary endpoint was the rate of 90 day major adverse neurological events, defined as minor stroke, major stroke, or death by independent neurological assessment.ResultsStent deployment was completed successfully in all cases without documented technical failure. There were no adverse neurological events or mortalities within 90 days. One thromboembolic occlusion of a small distal branch of the anterior cerebral artery occurred during the procedure and resolved with systemic recombinant tissue plasminogen activator administration. New ischemic lesions, all clinically silent, were seen in 6.5% of patients on post-procedure cerebral MRI.ConclusionThe Casper carotid stent demonstrated safety and efficacy in the treatment of carotid stenosis, with no technical failures and no adverse neurological events seen throughout the 90 day follow-up period. Its double layer structure seems to combine adequate plaque scaffolding with high vessel adaptability.
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Sannino A, Giugliano G, Toscano E, Schiattarella GG, Franzone A, Tesorio T, Trimarco B, Esposito G, Stabile E. Double layered stents for carotid angioplasty: A meta-analysis of available clinical data. Catheter Cardiovasc Interv 2017; 91:751-757. [DOI: 10.1002/ccd.27421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 09/26/2017] [Accepted: 10/30/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Anna Sannino
- Division of Cardiology; University of Naples “Federico II”; Naples Italy
- Department of Advanced Biomedical Sciences; University of Naples “Federico II”; Naples Italy
| | - Giuseppe Giugliano
- Division of Cardiology; University of Naples “Federico II”; Naples Italy
- Department of Advanced Biomedical Sciences; University of Naples “Federico II”; Naples Italy
| | - Evelina Toscano
- Division of Cardiology; University of Naples “Federico II”; Naples Italy
- Department of Advanced Biomedical Sciences; University of Naples “Federico II”; Naples Italy
| | - Gabriele G. Schiattarella
- Division of Cardiology; University of Naples “Federico II”; Naples Italy
- Department of Advanced Biomedical Sciences; University of Naples “Federico II”; Naples Italy
| | - Anna Franzone
- Division of Cardiology; University of Naples “Federico II”; Naples Italy
- Department of Advanced Biomedical Sciences; University of Naples “Federico II”; Naples Italy
| | - Tullio Tesorio
- Division of Invasive Cardiology; Clinica Montevergine; Mercogliano Italy
| | - Bruno Trimarco
- Division of Cardiology; University of Naples “Federico II”; Naples Italy
- Department of Advanced Biomedical Sciences; University of Naples “Federico II”; Naples Italy
| | - Giovanni Esposito
- Division of Cardiology; University of Naples “Federico II”; Naples Italy
- Department of Advanced Biomedical Sciences; University of Naples “Federico II”; Naples Italy
| | - Eugenio Stabile
- Division of Cardiology; University of Naples “Federico II”; Naples Italy
- Department of Advanced Biomedical Sciences; University of Naples “Federico II”; Naples Italy
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Umemoto T, de Donato G, Pacchioni A, Reimers B, Ferrante G, Isobe M, Setacci C. Optical coherence tomography assessment of newgeneration mesh-covered stents after carotid stenting. EUROINTERVENTION 2017; 13:1347-1354. [DOI: 10.4244/eij-d-16-00866] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Safety and Efficacy of the New Micromesh-Covered Stent CGuard in Patients Undergoing Carotid Artery Stenting: Early Experience From a Single Centre. Eur J Vasc Endovasc Surg 2017; 54:681-687. [DOI: 10.1016/j.ejvs.2017.09.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/23/2017] [Indexed: 11/19/2022]
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Kotsugi M, Takayama K, Myouchin K, Wada T, Nakagawa I, Nakagawa H, Taoka T, Kurokawa S, Nakase H, Kichikawa K. Carotid Artery Stenting: Investigation of Plaque Protrusion Incidence and Prognosis. JACC Cardiovasc Interv 2017; 10:824-831. [PMID: 28427600 DOI: 10.1016/j.jcin.2017.01.029] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/02/2017] [Accepted: 01/27/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study sought to clarify the incidence and prognosis of PP in carotid artery stenting (CAS). BACKGROUND Projections thought to be plaque may be observed inside the stent on angiography or intravascular ultrasound (IVUS) during CAS. Known as plaque protrusion (PP), the incidence and prognosis of this complication are unclear. METHODS A total of 354 consecutive carotid atherosclerotic stenoses in 328 patients (285 men, 43 women; age range 51 to 97 years [mean age 73.6 years]; 158 symptomatic cases; stenosis rate, 50% to 99% [mean 81.0%]) who underwent CAS under IVUS between October 2007 and March 2016 were retrospectively analyzed. PP was defined as plaque seen inside the stent lumen on both digital subtraction angiography and IVUS. The incidence and prognosis (rate of stroke within 30 post-operative days) of PP and the rate of ischemic lesions on the treated side on diffusion-weighted imaging performed within 48 post-operative hours within the PP group were investigated. RESULTS PP was observed in 9 cases (2.6%). Ischemic stroke occurred in 6 of 9 PP cases (66.7%; 1 major, 5 minor). Ischemic lesions were observed on diffusion-weighted imaging in 8 of 9 cases (88.9%). PP was strongly associated with perioperative ischemic stroke. A significant increase in PP susceptibility was observed with open-cell stent use and unstable plaque. CONCLUSIONS The incidence of PP in CAS was 2.6%, with a high risk of ischemic complications if PP was observed. The present findings indicate the necessity of appropriate device selection to avoid PP.
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Affiliation(s)
- Masashi Kotsugi
- Departments of Neurosurgery, Ishinkai Yao General Hospital, Yao, Japan.
| | - Katsutoshi Takayama
- Department of Radiology and Interventional Neuroradiology, Ishinkai Yao General Hospital, Yao, Japan
| | - Kaoru Myouchin
- Department of Radiology and Interventional Neuroradiology, Ishinkai Yao General Hospital, Yao, Japan
| | - Takeshi Wada
- Department of Radiology, Nara Medical University, Nara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | | | - Toshiaki Taoka
- Department of Radiology, Nara Medical University, Nara, Japan
| | | | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Nara, Japan
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Yoshimura S. Japanese Congress of Neurological Surgeons Presidential Address—Treatment of Carotid Artery Stenosis Based on Plaque Imaging. Neurosurgery 2017; 64:129-133. [DOI: 10.1093/neuros/nyx231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/27/2017] [Indexed: 11/12/2022] Open
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Setacci C, Mele M, de Donato G, Mazzitelli G, Benevento D, Palasciano G, Setacci F. Device selection for carotid stenting: reviewing the evidence. Expert Rev Cardiovasc Ther 2017; 15:787-796. [PMID: 28777008 DOI: 10.1080/14779072.2017.1364627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Carotid artery stenting (CAS) has recently changed the status in the treatment of the extracranial carotid atheromasic disease. In recent years, evolution in both stents and protection devices as well as in carotid stenting techniques, has resulted in an important reduction in the rate of stroke in patients undergoing CAS procedures. Areas covered: The purpose of this article is reviewing the literature and summarizing the current evidence of the new available materials to underline the importance of the correct choice of the devices during the procedure. Expert commentary: Certainly a key issue in order to limit the periprocedural events to the lowest possible, is to select the appropriate device for the appropriate patient anatomy and clinical syndrome, the so called 'tailored approach'.
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Affiliation(s)
- Carlo Setacci
- a Department of Vascular and Endovascular Surgery , University of Siena , Siena , Italy
| | - Mariagnese Mele
- a Department of Vascular and Endovascular Surgery , University of Siena , Siena , Italy
| | - Gianmarco de Donato
- a Department of Vascular and Endovascular Surgery , University of Siena , Siena , Italy
| | - Giulia Mazzitelli
- a Department of Vascular and Endovascular Surgery , University of Siena , Siena , Italy
| | - Domenico Benevento
- a Department of Vascular and Endovascular Surgery , University of Siena , Siena , Italy
| | - Giancarlo Palasciano
- a Department of Vascular and Endovascular Surgery , University of Siena , Siena , Italy
| | - Francesco Setacci
- a Department of Vascular and Endovascular Surgery , University of Siena , Siena , Italy
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Musiałek P, Hopkins LN, Siddiqui AH. One swallow does not a summer make but many swallows do: accumulating clinical evidence for nearly-eliminated peri-procedural and 30-day complications with mesh-covered stents transforms the carotid revascularisation field. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:95-106. [PMID: 28798779 PMCID: PMC5545669 DOI: 10.5114/pwki.2017.69012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/10/2017] [Indexed: 02/07/2023] Open
Abstract
Atherosclerotic carotid artery stenosis (CS) continues to be a common cause of acute ischaemic stroke. Optimised medical therapy (OMT), the first-line treatment modality in CS, may reduce or delay - but it does not abolish - CS-related strokes. As per current AHA/ASA and ESC/ESVS/ESO guidelines, carotid artery stenting (CAS) is a less-invasive alternative to carotid endarterectomy (CEA) for CS revascularisation in primary and secondary stroke prevention. Ten-year follow-up from the CREST trial in patients with symptomatic and asymptomatic CS confirmed equipoise of CAS and CEA in the primary endpoint. Nevertheless CAS - using a widely open-cell, first-generation stent and first-generation (distal/filter) neuroprotection - has been criticised for its relative excess of (mostly minor) strokes by 30 days, a significant proportion of which were post-procedural. Atherosclerotic plaque protrusion through conventional carotid stent struts, confirmed on intravascular imaging, has been implicated as a leading mechanism of the relative excess of strokes with CAS vs. CEA, including delayed strokes with CAS. Different designs of mesh-covered carotid stents have been developed to prevent plaque prolapse. Several multi-centre/multi-specialty clinical studies with CGurad MicroNet-Covered Embolic Prevention Stent System (EPS) and RoadSaver/Casper were recently published and included routine DW-MRI cerebral imaging peri-procedurally and at 30 days (CGuard EPS). Data from more than 550 patients in mesh-covered carotid stent clinical studies to-date show an overall 30-day complication rate of ~1% with near-elimination of post-procedural events. While more (and long-term) evidence is still anticipated, these results - taken together with optimised intra-procedural neuroprotection in CAS (increased use of proximal systems including trans-carotid dynamic flow reversal) and the positive 12-month mesh-covered stent data reports in 2017 - are transforming the carotid revascularisation field today. Establishing effective algorithms to identify the asymptomatic subjects at stroke risk despite OMT, and large-scale studies with mesh-covered stents including long-term clinical and duplex ultrasound outcomes, are the next major goals.
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Affiliation(s)
- Piotr Musiałek
- Department of Cardiac and Vascular Diseases, Jagiellonian University, School of Medicine, John Paul II Hospital, Krakow, Poland
| | - L. Nelson Hopkins
- Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Jacobs Institute, Gates Vascular Institute Kaleida Health, Buffalo, New York, USA
| | - Adnan H. Siddiqui
- Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Jacobs Institute, Gates Vascular Institute Kaleida Health, Buffalo, New York, USA
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Mesh-covered (Roadsaver) stent as a new treatment modality for symptomatic or high-risk carotid stenosis. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:130-134. [PMID: 28798783 PMCID: PMC5545667 DOI: 10.5114/pwki.2017.68139] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/18/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction Prevention of periprocedural stroke has a crucial role in carotid artery stenting (CAS) procedures. Aim To assess retrospectively 30-day safety and effectiveness of 41 procedures of internal and common carotid artery stenting using the Roadsaver double nitinol layer micromesh stent in 40 non-consecutive patients with symptomatic or high-risk carotid artery stenosis. Material and methods The patients were men (n = 31) and women (n = 9); mean age was 67.8 ±7.9 years. Femoral access was used in 39 cases, whereas radial access was used in 2. Proximal (n = 27) or distal (n = 14) embolic neuroprotection was used. Results The Roadsaver stents (nominal diameter 7, 8 or 9 mm, length 25 or 30 mm) were implanted successfully in all cases. One minor stroke occurred after common carotid artery intubation with a guiding catheter (before stent deployment) and one transient postprocedural ischemic attack (TIA) of the ipsilateral cerebral hemisphere was observed. Internal/common carotid artery stenosis severity was evaluated by duplex Doppler. Maximal peak systolic velocity (PSV) before CAS was in the range: 2.0–7.0 m/s, mean: 3.9 ±1.0 m/s, at 24–48 h after stenting mean PSV was 1.1 ±0.4 m/s (p < 0.05), and at 30 days 1.1 ±0.3 m/s (p < 0.05). Maximal end-diastolic velocity (EDV) was 0.85–3.5 m/s, mean 1.4 ±0.5 m/s, at 24–48 h after stenting mean EDV was 0.3 ±0.1 m/s (p < 0.05), and at 30 days 0.4 ±0.1 m/s (p < 0.05). No restenosis or thrombosis was observed. Angiographic stenosis decreased from 82.9 ±9.1% (range: 61–97%) to 19.3 ±7.3% (range: 0–34%) (p < 0.05). Conclusions The CAS using the Roadsaver stent seems to be safe and effective. Further studies involving larger patient populations and longer follow-up are needed.
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Diaz O, Lopez G, Roehm JOF, De la Rosa G, Orozco F, Almeida R. The Casper carotid artery stent: a unique all metal micromesh stent designed to prevent embolic release. J Neurointerv Surg 2017; 10:133-136. [DOI: 10.1136/neurintsurg-2016-012913] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 01/26/2017] [Indexed: 11/04/2022]
Abstract
BackgroundStroke due to the release of embolic debris during the placement of a stent to correct carotid artery stenosis is a constant procedural and peri-procedural threat. The new all metal Casper stent has been created with two layers of nitinol, the inner layer of which has pores diminutive enough to prevent embolic release.ObjectiveTo evaluate the safety, effectiveness, and utility of the double layer nitinol Casper carotid artery stent in the treatment of patients with severe carotid artery stenosis.Methods19 patients with severe internal carotid artery stenosis, 14 symptomatic and 5 asymptomatic, were treated with the Casper stent. After stent placement, angiographic and cone beam CT images were recorded in all patients.ResultsThe unique low profile delivery system allowed for easy stent placement, re-sheathing, and repositioning of the stent. The large cell external layer produced excellent apposition to the artery wall. The inner layer prevented prolapse of atherosclerotic debris through the device. Plaque coverage was achieved; residual stenosis ranged from 0% to 20%. Long term angiographic follow-up in 5 patients showed wall apposition of the device covering the lesion and no restenosis. There were no procedure related complications. Two patients experienced a delayed ischemic stroke, likely related to inconsistent medical management.ConclusionsThe Casper has been an excellent stent for the treatment of internal carotid artery stenosis and its internal micromesh layer has been effective in preventing plaque prolapse. It provides the flexibility of large cell stents and the inner layer provides maximum protection against plaque prolapse.
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Use of Micropatterned Thin Film Nitinol in Carotid Stents to Augment Embolic Protection. J Funct Biomater 2016; 7:jfb7040034. [PMID: 27983574 PMCID: PMC5197993 DOI: 10.3390/jfb7040034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/05/2016] [Accepted: 12/09/2016] [Indexed: 12/29/2022] Open
Abstract
Stenting is an alternative to endarterectomy for the treatment of carotid artery stenosis. However, stenting is associated with a higher risk of procedural stroke secondary to distal thromboembolism. Hybrid stents with a micromesh layer have been proposed to address this complication. We developed a micropatterned thin film nitinol (M-TFN) covered stent designed to prevent thromboembolism during carotid intervention. This innovation may obviate the need or work synergistically with embolic protection devices. The proposed double layered stent is low-profile, thromboresistant, and covered with a M-TFN that can be fabricated with fenestrations of varying geometries and sizes. The M-TFN was created in multiple geometries, dimensions, and porosities by sputter deposition. The efficiency of various M-TFN to capture embolic particles was evaluated in different atherosclerotic carotid stenotic conditions through in vitro tests. The covered stent prevented emboli dislodgement in the range of 70%–96% during 30 min duration tests. In vitro vascular cell growth study results showed that endothelial cell elongation, alignment and growth behaviour silhouettes significantly enhance, specifically on the diamond-shape M-TFN, with the dimensions of 145 µm × 20 µm and a porosity of 32%. Future studies will require in vivo testing. Our results demonstrate that M-TFN has a promising potential for carotid artery stenting.
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Musialek P, Hopf-Jensen S. Commentary: Carotid Artery Revascularization for Stroke Prevention: A New Era. J Endovasc Ther 2016; 24:138-148. [PMID: 27733691 DOI: 10.1177/1526602816671263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Piotr Musialek
- 1 Jagiellonian University Department of Cardiac & Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Silke Hopf-Jensen
- 2 Department of Diagnostic and Interventional Radiology and Neuroradiology, Diakonissenhospital Flensburg, Germany
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Nerla R, Castriota F, Micari A, Sbarzaglia P, Secco GG, Ruffino MA, de Donato G, Setacci C, Cremonesi A. Carotid artery stenting with a new-generation double-mesh stent in three high-volume Italian centres: clinical results of a multidisciplinary approach. EUROINTERVENTION 2016; 12:e677-83. [PMID: 27497367 DOI: 10.4244/eijv12i5a109] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS Carotid artery stenting (CAS) is still associated with higher periprocedural cerebrovascular events (CEs) compared to vascular surgery. The Roadsaver carotid artery stent is a double layer micromesh stent which reduces plaque prolapse and embolisation by improving plaque coverage. Its clinical impact on neurological outcome was unknown. The aim of this study was therefore to report the clinical results of a large real-world population from three different centres receiving a Roadsaver stent to treat carotid artery disease. METHODS AND RESULTS One hundred and fifty (150) patients (age 74±8 yrs, 75% male, symptomatic 29%) treated with CAS using the Roadsaver carotid stent in three high-volume Italian centres were included in the study. Intraprocedural optical coherence tomography (OCT) evaluation was performed in 26 patients, with an off-line analysis by a dedicated core laboratory. All patients underwent duplex ultrasound and neurological evaluation at 24 hours and at 30 days. CAS was technically successful in all cases (stent diameter: 8.6±0.8 mm, stent length: 25.0±4.5 mm). No in-hospital or 30-day CEs were observed. OCT evaluation detected a low rate of plaque prolapse (two patients, 7.7%). Duplex ultrasound showed stent and external carotid artery patency in all cases both before discharge and at 30-day follow-up. CONCLUSIONS The Roadsaver stent is a safe and promising technology for CAS, with a low percentage of plaque prolapse and good short-term clinical outcome. Larger studies with longer follow-up are necessary to confirm this favourable clinical outcome.
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Affiliation(s)
- Roberto Nerla
- Interventional Cardiology Unit, Maria Cecilia Hospital, Cotignola, Italy
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Stabile E, Tesorio T, Esposito G. The modern approach to endovascular carotid revascularisation. EUROINTERVENTION 2016; 12:e538-40. [DOI: 10.4244/eijv12i5a92] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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