Novel PARADIGM in carotid revascularisation: Prospective evaluation of All-comer peRcutaneous cArotiD revascularisation in symptomatic and Increased-risk asymptomatic carotid artery stenosis using CGuard™ MicroNet-covered embolic prevention stent system

Abstract

These increased risk consecutive patient data (1) indicate safety and efficacy of routine MN-EPS use in achieving endovascular reconstruction across all-comer CS lesion subsets, and (2) are consistent with MN-EPS protection against cerebral events extending throughout the stent healing period.

Commentary: Carotid Artery Revascularization for Stroke Prevention

“…The symptomatic transformation of atherosclerotic CS, however, is far from being eradicated. Consequently, contemporary carotid revascularization studies [11][12][13] continue to include up to 55% symptomatic subjects in all-comer patient series. 11 A significant proportion of these patients are already on antiplatelet and maximized statin treatment prior to the CS-associated stroke events, 11,14,15 consistent with the fact that medical therapy reduces but does not abolish the CS stroke risk.…”

“…39 Indeed, until (and if ever) recalled on the basis of prospective validation, the above (and other) increased-risk features can be incorporated into a multispecialty neurovascular team (NVT) clinical decision-making algorithm. 11 As with any interventional management, the risk of stroke death or severe disability, with extremely high personal and social costs, 27,28 needs to be weighed against the procedural risk(s) of carotid revascularization. 3 Neurology postulated that revascularization would be appropriate in low-stroke-risk CS patients only if it could be performed with a risk <1%.…”

“…[57][58][59] According to "tailored CAS" algorithms, 11,53,60 proximal neuroprotection is preferred in endovascular management of symptomatic and high-risk asymptomatic lesions. The use of ultra-closed-cell stent systems (achieved by covering the nitinol frame with a mesh made of different materials), on the other hand, not only further reduces the risk of intraprocedural neurologic complications but also, by preventing plaque protrusion through stent struts, eliminates postprocedural cerebral embolization as manifested on routine diffusion-weighted magnetic resonance imaging (DW-MRI).…”

“…This makes the CGuard EPS (with 6-F outer diameter of the packed delivery system) the most "open" and, at the same time, the most "closed"-cell carotid stent among the current designs. 11 Unsurprisingly, the tightly packed ultra-closed-cell mesh CGuard has a relatively high bending stiffness prior to delivery, 62 but after implantation it shows an extremely high flexibility and wall adaptation 62 exceeding that of RoadSaver/Casper. 65 CGuard EPS has a high radial force that is similar to the Precise stent and is higher than that of RoadSaver/Casper.…”

The year in cardiology 2016: peripheral circulation

“…4 Suprotno tomu, karotidni plakovi ostaju važno pomagalo za stratifikaciju KV rizika. U 2016. godini dugoročna klinička ravnoteža u praćenju stentiranja karotidnih arterija (CAS) u odnosu prema karotidnoj endarterektomiji (CEA) potvrđena je 10-godišnjom analizom u studiji CREST (Carotid Revascularisation Endarecteromy vs. Stenting Trial), gdje analiza pokazuje sličnu učestalost smrtnosti, moždanih udara, infarkta miokarda unutar 30 dana, ili ipsilateralnog moždanog udara do 10 godina za obje strategije (11,8 % prema 9,9 %; P = 0,51) (Tablica 1). 5 Periproceduralni moždani udar tijekom CAS-a obično je povezan s embolizacijom plaka.…”