Related Experiment Video

Updated: Aug 5, 2026

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
09:36

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis

Published on: August 12, 2025

Plaque Prolapse in Carotid Artery Stenting: Mechanisms, Imaging and Device-Based Prevention

Luca Galassi1, Leonardo Pasquetti2, Federica Facchinetti3

  • 1Postgraduate School of Vascular and Endovascular Surgery, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy.

Medicina (Kaunas, Lithuania)
|July 28, 2026
PubMed

Insights

Preventing plaque prolapse during carotid artery stenting (CAS) is crucial for reducing stroke risk. Dual-layer micromesh stents (DLMS) combined with embolic protection offer an advanced solution, significantly lowering periprocedural embolization and improving patient outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Neurology
  • Medical Device Technology

Background:

  • Carotid artery stenting (CAS) is a key treatment for high-risk surgical patients with carotid disease.
  • Periprocedural cerebral embolization is a significant concern, with plaque prolapse identified as a direct cause of embolic events.
  • Understanding and preventing plaque prolapse is essential for improving neurological outcomes after CAS.

Purpose of the Study:

  • To provide a practice-oriented framework for preventing plaque prolapse during CAS.
  • To review determinants of prolapse risk, including plaque morphology, procedural factors, and device selection.
  • To highlight dual-layer micromesh stent (DLMS) technology as a potential solution.

Main Methods:

  • Narrative review of prospective registries, comparative cohort studies, and intravascular imaging analyses (OCT, IVUS).
  • Analysis of plaque morphology, procedural variables, and device characteristics influencing prolapse risk.
  • Evaluation of clinical data on DLMS technology and its association with stroke rates and prolapse reduction.

Main Results:

  • Pooled data show a 30-day stroke rate of approximately 1.4% with DLMS and embolic protection.
  • Optical coherence tomography (OCT) studies demonstrate reduced prolapse with DLMS compared to single-layer stents.
  • Integrated strategies involving lesion characterization, technique optimization, and device selection are key to prevention.

Conclusions:

  • Prevention of plaque prolapse requires a multifaceted approach combining imaging, technique, and device selection.
  • DLMS technology represents an advanced device-based strategy for minimizing prolapse during CAS.
  • Further research with standardized imaging and robust clinical endpoints is needed to refine prevention strategies.

Keywords:
CGuardRoadsavercarotid artery stentingcerebral embolizationdual-layer micromesh stentoptical coherence tomographyplaque prolapsevulnerable plaque

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