Intraprocedural and Delayed Plaque Protrusion in Carotid Artery Stenting Using a Dual-Layer Metallic Stent

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Device Technology

Background:

• Carotid artery stenting (CAS) with conventional stents is linked to plaque protrusion (PP), increasing embolism risk.
• The Casper/Roadsaver stent (CRS) features a dual-layer micromesh design to mitigate PP.
• This study evaluates PP incidence using the CRS in CAS procedures.

Purpose of the Study:

• To assess the incidence of intraprocedural and delayed plaque protrusion (PP) with Casper/Roadsaver stent (CRS) during carotid artery stenting (CAS).
• To evaluate the safety and efficacy of CRS in CAS, including diffusion-weighted imaging lesions and major adverse events.

Main Methods:

• Prospective analysis of 89 carotid artery stenoses in 82 patients undergoing CAS with CRS under intravascular ultrasound.
• Primary endpoints included technical success, intraprocedural and delayed PP, diffusion-weighted imaging lesions, and 30-day major adverse events.
• Secondary endpoints were in-stent restenosis and ipsilateral stroke at 12 months.

Main Results:

• 100% technical success rate for CAS with CRS.
• Intraprocedural PP occurred in 2.2% of patients; delayed PP (at 7 days) in an additional 3.4%.
• Diffusion-weighted imaging positivity was 24.7%, with one minor stroke (1.1%) and 6.0% in-stent restenosis by 12 months.

Conclusions:

• CRS CAS demonstrated a significantly lower incidence of intraprocedural plaque protrusion (PP) compared to conventional stents.
• A notable incidence of delayed PP was observed, highlighting the need for post-CAS follow-up in patients treated with CRS.