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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Incidence, Timing and Associated Factors of In-Stent Restenosis after CASPER Placement: A Single-Center Retrospective
Yasutaka Murakami1, Shuta Aketa2, Kenji Fukutome2
1Department of Neurology, Osaka Keisatsu Hospital, Osaka, Osaka, Japan.
Insights
In-stent restenosis (ISR) after CASPER stent placement occurred in 12.5% of patients within 18 months. Lower plaque-to-muscle ratio and smaller stent diameter were linked to ISR development. Further research is needed for long-term outcomes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- The CASPER stent is a dual-layer micromesh device for carotid artery stenting, aiming to reduce stroke risk.
- In-stent restenosis (ISR) is a known complication of carotid stenting.
- Data on ISR incidence and risk factors specifically for the CASPER stent in Japan is limited.
Purpose of the Study:
- To evaluate the incidence and timing of ISR after CASPER stent placement.
- To identify factors associated with ISR development in patients treated with the CASPER stent.
Main Methods:
- Retrospective analysis of 80 consecutive patients who underwent CASPER stent placement.
- Review of preprocedural plaque characteristics (including T1-weighted MRI for plaque-to-muscle ratio - PMR), procedural details, and follow-up carotid ultrasound.
- ISR defined as luminal narrowing ≥50% (symptomatic) or ≥70% (asymptomatic).
Main Results:
- ISR occurred in 10 patients (12.5%) over a mean follow-up of 27.6 months, with a median onset of 8.5 months (range 1.8-16.4 months).
- Patients with ISR had significantly lower PMR values (1.45 vs. 1.90, p=0.024) and smaller stent diameters (median 7.5 vs. 8.0 mm, p=0.029).
- A trend towards increased ipsilateral ischemic stroke was observed in patients with ISR (20.0% vs. 2.9%, p=0.056).
Conclusions:
- ISR after CASPER stenting typically occurs within 18 months.
- Lower plaque-to-muscle ratio and smaller stent diameter are associated with ISR in this cohort.
- Larger studies are warranted to confirm these findings and assess long-term outcomes of the CASPER stent.
Objective:
The CASPER stent (Terumo, Tokyo, Japan) is a dual-layer micromesh device designed to prevent plaque prolapse into the stent struts and reduce perioperative stroke risk. However, the in-stent restenosis (ISR) incidence and associated factors after CASPER placement in Japan remain insufficiently investigated. This study aimed to evaluate the ISR rate, timing, and associated factors after CASPER placement.
Methods:
Eighty consecutive patients who underwent carotid artery stenting with a CASPER stent at a single institution between March 2021 and December 2023 were retrospectively analyzed. Preprocedural plaque characteristics, procedural details, and follow-up carotid artery ultrasound findings were reviewed. ISR was defined as luminal narrowing ≥50% in patients with neurological symptoms attributable to the ISR lesion and ≥70% in patients without such symptoms.
Results:
Over a mean follow-up of 27.6 ± 9.9 months, ISR occurred in 10 patients (12.5%). ISR developed 1.8-16.4 months after the index procedure, with a median time of 8.5 months. Patients with ISR had lower plaque-to-muscle ratio (PMR) values on T1-weighted MRI than patients without ISR (1.45 vs. 1.90, p = 0.024). Furthermore, stent diameter was smaller in patients with ISR than in those without it (median 7.5 vs. 8.0 mm, p = 0.029). During follow-up beyond 30 days after stent placement, ipsilateral ischemic stroke tended to occur more frequently in patients with ISR than in those without it (20.0% vs. 2.9%, p = 0.056).
Conclusion:
In patients treated with CASPER, ISR occurred within the first 18 months after treatment. Lower PMR values and smaller stent diameters were associated with ISR in this cohort. Larger studies with long-term follow-up are required to confirm these findings and assess CASPER stent long-term outcomes.
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