Contemporary Results of Carotid Artery Stenting Using Low-Profile Dual-Metal Layer Nitinol Micromesh Stents in Relation to Single-Layer Carotid Stents

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.

Comparison of the Outcome and Efficacy of Single-Layer versus Dual-Layer Mesh Stent among Carotid Stenosis Patients Attending a Tertiary Care Setting—A Prospective Observational Study

“…15 A comparison study conducted by Kahlberg et al reported almost similar results in both the groups in terms of postprocedural adverse events, namely, TIA/stroke/mortality with 3% in dual-layer stenting group and 1% in single-layer stenting group. 16 This result is in same line with our study results of similar percentage population in both the groups presented postprocedural adverse events (26.32% in single-layer stenting group and 27.27% in dual-layer stenting group presented TIA). Lal et al found several stents used, lesion characteristics (length, ulceration), and procedural related risk factors of CAS playing a major role in CAS outcomes.…”

CIRSE Standards of Practice on Carotid Artery Stenting

“…However, available data remain very limited and only small studies have been published, indicating optimistic results [ 55 – 57 ]. Short- and long-term safety and efficacy of a dual-layer micromesh stent (DLMS) has already been shown in a number of studies [ 21 , 58 , 59 ]. A current multi-national, multi-specialty study aims to expand the clinical evidence base and confirm the good performance of the DLMS, now in a large, unselected patient cohort eligible for an elective CAS treatment as per routine care.…”

Carotid Artery Stenting With Double-Layer Stent: A Systematic Review and Meta-Analysis

“…Figure 1 reports the literature search and the process of papers selection for this study. After the screening process and duplicate studies removal, a total of 14 papers [16][17][18][19][20][21][22][23][24][25][26][27][28][29] were included in the analysis. Tables 1 and 2 report the characteristics of the studies included.…”