Randomized Controlled Trial of Conventional Versus MicroNet-Covered Stent in Carotid Artery Revascularization

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Neurology

Background:

• Carotid artery stenting (CAS) carries a risk of periprocedural cerebral embolism.
• Conventional stents like Acculink may not fully mitigate this risk.
• Evidence for the efficacy of MicroNet-covered stents (CGuard) in preventing embolism is limited.

Purpose of the Study:

• To compare the incidence and volume of cerebral embolism between Acculink and CGuard stents during CAS.
• To evaluate the effectiveness of the MicroNet-covered stent in reducing periprocedural and postprocedural cerebral lesions.
• To assess the impact of stent type on permanent lesion development and stroke risk.

Main Methods:

• A randomized trial (SIBERIA Trial) involving 100 patients undergoing filter-protected CAS.
• Patients were assigned 1:1 to receive either the Acculink or CGuard stent.
• Diffusion-weighted MRI was used to quantify cerebral lesion volume 48 hours postprocedure.

Main Results:

• The CGuard group showed a 78.4% reduction in total postprocedural cerebral lesion volume compared to the Acculink group.
• Average lesion volume per affected patient and per lesion was significantly lower in the CGuard group.
• The Acculink stent significantly increased the risk of multiple cerebral lesions, and CGuard demonstrated a 92.3% reduction in permanent lesion volume at 30 days.

Conclusions:

• The MicroNet-covered stent (CGuard) significantly reduces periprocedural cerebral embolism in CAS.
• CGuard provides sustained embolism prevention, offering cerebral protection during and after the procedure.
• These findings suggest CGuard may influence clinical decision-making in carotid revascularization.