Prospective, multicenter European study of the GORE flow reversal system for providing neuroprotection during carotid artery stenting

Abstract

Use of the GORE Flow Reversal System during CAS had a high rate of technical success and low 30-day rates of adverse neurologic and cardiac events.

Safety and efficacy of endovascular treatment for carotid artery stenoses using proximal protection systems: 30-day follow-up

“…The death/stroke rates in this study in the symptomatic, asymptomatic, and patients older than 80 years were 2.6%, 3%, and 2.6%, respectively [21]. Another study on the use of the Gore Flow Reversal System, which was published in 2012 by Nikas et al, revealed complication rate (comprising: stroke, death and myocardial infarction) at the level of 1.6% [22]. Similarly, clinical benefit associated with the use of a PPS has been demonstrated by cerebral diffusion MR studies.…”

“…In selected cases (there were 2 such patients) we utilised both proximal and distal protections. Such a dual protection has already been shown to be safe and effective [22,26]. Also, we applied lesion-tailored stents: preferentially closed-cell stents, but in selected patients who presented with tortuous arteries we implanted stents with an open-cell design (such as the Precise stent/Cordis, Fremont, CA, USA).…”

Commentary: Carotid Artery Revascularization for Stroke Prevention

“…Technological advancements, including mesh-covered carotid stents for sustained embolic prevention, 11,13,62,64,65,72 taken together with optimized use of temporary protection (with a focus on proximal protection systems for high-risk lesion subsets in particular 11,53,54,56,57,60,66 ) and increased endovascular operator experience 70 may ultimately make CAS a safer procedure that CEA. 35 …”

“…[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).…”

Techniques for Optimizing Results in Carotid Stenting

“…Intolerance to flow blockage is also encountered in 5.7-7.6 % of the patients [63] and could be dangerous in those with contralateral carotid occlusion. Nevertheless, this type of cerebral protection has been reported to be safe and effective in recent series, with a low rate of procedural adverse events [64]. Recent studies suggest that the differential in adverse neurologic event rates in CAS between symptomatic and asymptomatic patients may be ameliorated Curr Surg Rep (2013) 1: 78-89 83 by the use of flow reversal embolic protection strategies in symptomatic patients.…”