Comparison of Restenosis Risk in Single-Layer Versus Dual-Layer Carotid Stents: A Duplex Ultrasound Evaluation

Overview

Journal Cardiovasc Intervent Radiol

Specialty Cardiology & Vascular Diseases

Date 2022 Jul 7

PMID 35798859

Authors

Jan Sykora

Kamil Zelenak

Martin Vorcak

Martin Stevik

Martina Sykorova

Jozef Sivak

Marek Rovnak

Jana Zapletalova

Juraj Muzik

Igor Sinak

Egon Kurca

Lukas Meyer

Jens Fiehler

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this study was to report intermediate-term results of duplex ultrasound follow-up of carotid artery stenting performed with the dual-layer stent as compared to concurrent patients treated with other commercially available single-layer carotid stents.

Materials And Methods: A single centre, retrospective, nonrandomized study including 162 non-consecutive patients with 199 implanted carotid stents treated over a 7-year period was conducted. Patients with at least one ultrasound examination after treatment were included. Procedural and follow-up data for patients treated with the dual-layer stent implantation (83 stents) vs first-generation carotid stents implantations (116 stents) were compared.

Results: The median follow-up time was 24.0 months (IQR 10-32 months) for dual-layer stents and 27.5 months (IQR 10.3-59 months) for single-layer stents. The rate of severe restenosis was significantly higher in the dual-layer stent group than in the single-layer group (13.3% [11/83] vs 3.4% [4/116], p = 0.01). Seven reinterventions were performed in 5 patients with dual-layer stents. The rate of reintervention was significantly higher compared to no reinterventions in single-layer stents (6% [5/83] vs 0% [0/116], p = 0.012). Patients with restenosis had significantly higher presence of dyslipidaemia (100% [12/12] vs 63.3% [95/150], p = 0.009).

Conclusions: In this real-world cohort of patients undergoing carotid artery stenting, the patients treated with low-profile dual-layer micromesh stent showed higher rates of restenosis and reinterventions compared to first-generation single-layer stents.

Citing Articles

The Dual-layer CGuard Stent Is Safe and Effective in Emergent Carotid Artery Stenting and in Tandem Occlusions: a Multi-centric Study.

Zidan M, Voss Y, Wolf M, Keil F, Brockmann C, Gronemann C Clin Neuroradiol. 2024; 35(1):77-85.

PMID: 39225802 PMC: 11832600. DOI: 10.1007/s00062-024-01455-7.

Stenting with dual-layer CGuard stent in acute sub-occlusive carotid artery stenosis and in tandem occlusions: a monocentric study.

Zidan M, Gronemann C, Lehnen N, Bode F, Weller J, Petzold G Neuroradiology. 2024; 66(9):1635-1644.

PMID: 38844697 PMC: 11322317. DOI: 10.1007/s00234-024-03397-w.

Intraprocedural Plaque Protrusion during Carotid Artery Stenting with a CASPER Stent: A Case Report.

Wada T, Takayama K, Myouchin K, Oshima K, Tanaka T, Kichikawa K J Neuroendovasc Ther. 2023; 17(1):32-36.

PMID: 37501884 PMC: 10370511. DOI: 10.5797/jnet.cr.2022-0054.

Clinical results of 30 consecutive patients of carotid artery stenosis treated with CASPER stent placement: 1-year follow-up and in-stent findings on intravascular ultrasound examination immediately and 6 months after treatment.

Matsumoto H, Izawa D, Nishiyama H, Nakayama Y, Maeshima K J Neurointerv Surg. 2023; 16(7):715-720.

PMID: 37399338 PMC: 11228187. DOI: 10.1136/jnis-2023-020186.

Clinical Outcomes of Second- versus First-Generation Carotid Stents: A Systematic Review and Meta-Analysis.

Mazurek A, Malinowski K, Rosenfield K, Capoccia L, Speziale F, De Donato G J Clin Med. 2022; 11(16).

PMID: 36013058 PMC: 9409706. DOI: 10.3390/jcm11164819.

References

Kammler J, Blessberger H, Lambert T, Kellermair J, Grund M, Nahler A . In-stent restenosis after interventional treatment of carotid artery stenoses: a long-term follow-up of a single center cohort. Clin Res Cardiol. 2017; 106(7):493-500. DOI: 10.1007/s00392-017-1078-1. View

Stabile E, Garg P, Cremonesi A, Bosiers M, Reimers B, Setacci C . European Registry of Carotid Artery Stenting: results from a prospective registry of eight high volume EUROPEAN institutions. Catheter Cardiovasc Interv. 2012; 80(2):329-34. DOI: 10.1002/ccd.24348. View

Aboyans V, Ricco J, Bartelink M, Bjorck M, Brodmann M, Cohnert T . 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric,.... Eur Heart J. 2017; 39(9):763-816. DOI: 10.1093/eurheartj/ehx095. View

Brott T, Halperin J, Abbara S, Bacharach J, Barr J, Bush R . 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. A report of the American College of Cardiology Foundation/American.... Circulation. 2011; 124(4):489-532. DOI: 10.1161/CIR.0b013e31820d8d78. View

Schofer J, Musialek P, Bijuklic K, Kolvenbach R, Trystula M, Siudak Z . A Prospective, Multicenter Study of a Novel Mesh-Covered Carotid Stent: The CGuard CARENET Trial (Carotid Embolic Protection Using MicroNet). JACC Cardiovasc Interv. 2015; 8(9):1229-1234. DOI: 10.1016/j.jcin.2015.04.016. View

Nerla R, Micari A, Castriota F, Micciche E, Ruffino M, De Donato G . Carotid artery stenting with a new-generation double-mesh stent in three high-volume Italian centres: 12-month follow-up results. EuroIntervention. 2018; 14(10):1147-1149. DOI: 10.4244/EIJ-D-18-00513. View

Capoccia L, Sirignano P, Mansour W, dAdamo A, Sbarigia E, Mariani P . Peri-procedural brain lesions prevention in CAS (3PCAS): Randomized trial comparing CGuard™ stent vs. Wallstent™. Int J Cardiol. 2018; 279:148-153. DOI: 10.1016/j.ijcard.2018.09.066. View

Ruffino M, Faletti R, Fronda M, Gatti M, Bergamasco L, Gibello L . Early Embolization After Carotid Artery Stenting with Mesh-Covered Stent: Role of Diffusion-Weighted Magnetic Resonance Imaging as Pre-procedural Predictor and Discriminant Between Intra- and Post-procedural Events. Cardiovasc Intervent Radiol. 2019; 42(6):812-819. DOI: 10.1007/s00270-019-02173-1. View

Yilmaz U, Korner H, Muhl-Benninghaus R, Simgen A, Kraus C, Walter S . Acute Occlusions of Dual-Layer Carotid Stents After Endovascular Emergency Treatment of Tandem Lesions. Stroke. 2017; 48(8):2171-2175. DOI: 10.1161/STROKEAHA.116.015965. View

10.

Machnik R, Paluszek P, Tekieli L, Dzierwa K, Maciejewski D, Trystula M . Mesh-covered (Roadsaver) stent as a new treatment modality for symptomatic or high-risk carotid stenosis. Postepy Kardiol Interwencyjnej. 2017; 13(2):130-134. PMC: 5545667. DOI: 10.5114/pwki.2017.68139. View

11.

Hopf-Jensen S, Marques L, Preiss M, Muller-Hulsbeck S . Initial clinical experience with the micromesh Roadsaver carotid artery stent for the treatment of patients with symptomatic carotid artery disease. J Endovasc Ther. 2015; 22(2):220-5. DOI: 10.1177/1526602815576337. View

12.

Bosiers M, Deloose K, Torsello G, Scheinert D, Maene L, Peeters P . The CLEAR-ROAD study: evaluation of a new dual layer micromesh stent system for the carotid artery. EuroIntervention. 2016; 12(5):e671-6. DOI: 10.4244/EIJY16M05_04. View

13.

Stabile E, De Donato G, Musialek P, Deloose K, Nerla R, Sirignano P . Use of Dual-Layered Stents for Carotid Artery Angioplasty: 1-Year Results of a Patient-Based Meta-Analysis. JACC Cardiovasc Interv. 2020; 13(14):1709-1715. DOI: 10.1016/j.jcin.2020.03.048. View

14.

Imamura H, Sakai N, Matsumoto Y, Yamagami H, Terada T, Fujinaka T . Clinical trial of carotid artery stenting using dual-layer CASPER stent for carotid endarterectomy in patients at high and normal risk in the Japanese population. J Neurointerv Surg. 2020; 13(6):524-529. PMC: 8142440. DOI: 10.1136/neurintsurg-2020-016250. View

15.

Vanzin J, de Castro-Afonso L, Santos M, Manzato L, Nakiri G, Moretti Monsignore L . Casper vs. Closed-Cell Stent : Carotid Artery Stenting Randomized Trial. Clin Neuroradiol. 2020; 31(3):843-852. DOI: 10.1007/s00062-020-00937-8. View

16.

Economopoulos K, Sergentanis T, Tsivgoulis G, Mariolis A, Stefanadis C . Carotid artery stenting versus carotid endarterectomy: a comprehensive meta-analysis of short-term and long-term outcomes. Stroke. 2011; 42(3):687-92. DOI: 10.1161/STROKEAHA.110.606079. View

17.

Wasser K, Schnaudigel S, Wohlfahrt J, Psychogios M, Schramm P, Knauth M . Clinical impact and predictors of carotid artery in-stent restenosis. J Neurol. 2012; 259(9):1896-902. PMC: 3432778. DOI: 10.1007/s00415-012-6436-3. View

18.

Lal B, Beach K, Roubin G, Lutsep H, Moore W, Malas M . Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial. Lancet Neurol. 2012; 11(9):755-63. PMC: 3912998. DOI: 10.1016/S1474-4422(12)70159-X. View

19.

Bonati L, Ederle J, McCabe D, Dobson J, Featherstone R, Gaines P . Long-term risk of carotid restenosis in patients randomly assigned to endovascular treatment or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial. Lancet Neurol. 2009; 8(10):908-17. PMC: 2755038. DOI: 10.1016/S1474-4422(09)70227-3. View

20.

Bonati L, Gregson J, Dobson J, McCabe D, Nederkoorn P, van der Worp H . Restenosis and risk of stroke after stenting or endarterectomy for symptomatic carotid stenosis in the International Carotid Stenting Study (ICSS): secondary analysis of a randomised trial. Lancet Neurol. 2018; 17(7):587-596. PMC: 6004555. DOI: 10.1016/S1474-4422(18)30195-9. View