Efficacy of Micromesh-Covered Stents in Carotid Artery Stenting

Most literature, old and recent, associates carotid artery stenting with a higher rate of stroke (although minor) when compared with carotid endarterectomy during the acute period. However, 30-day outcomes of angioplasty and surgery are comparable.

Many technical advancements, including new stent designs and different cerebral protection mechanisms, have improved the outcomes of angioplasty in clinical terms as well as in new cerebral magnetic resonance imaging scans.

This single-center study assesses the new CGuard carotid stent, a nitinol stent covered by a closed-cell (<180 µm) polyethylene terephthalate (PET) micromesh designed to prevent cerebral embolic events caused by plaque protrusion. This stent applies the technology behind the MGuard device, designed for coronary arteries and tested in the Master trial as published in CircCardiovascInterv 2015.

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Eighty-two consecutive patients who underwent carotid artery stenting with CGuard were enrolled and assessed regarding both clinical and imaging endpoints.

Among them, 19% were asymptomatic at the time the procedure was performed and mean stenosis was 81.4 ± 4.9%.

There was technical success in 100% of all symptomatic patients, and in 98.5% of all asymptomatic patients due to the occurrence of one acute stent thrombosis event 4 hours after the procedure, which was associated with a minor stroke. In the immediate post-operative period (30 days), there were no events.

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New ischemic brain lesions were observed during a diffusion weighted magnetic resonance imaging in 23.8% of patients, and the average lesion volume per patient was 0.039 ± 0.025 cm³.

Conclusion

The technical and clinical success of this new device turns it into a safe and effective option for the treatment of carotid lesions, regardless of aortic arch anatomy.

Editorial

Carotid artery stenting is sometimes a technically demanding procedure, which means that the existence of a learning curve is undeniable.

Many early trials on this subject reporting suboptimal outcomes for angioplasty were criticized for the inexperience of participating operators, and Dr. Brahmajee’s work published in JAMA proves the association between inexperience and mortality.

This study was carried out in a single center with a single operator who takes part in over 85 carotid artery stenting procedures per year. Undoubtedly, procedures within this study were performed by an expert, but this fact impacts negatively on the external validity and reproducibility of this work.

Original title: Safety and Efficacy of the New Micromesh-Covered Stent CGuard in Patients Undergoing Carotid Artery Stenting: Early Experience from a Single Centre.

Reference: Renato Casana et al. Eur J Vasc Endovasc Surg (2017), article in press.

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