JACC: Cardiovascular Interventions
Use of Dual-Layered Stents in Endovascular Treatment of Extracranial Stenosis of the Internal Carotid ArteryResults of a Patient-Based Meta-Analysis of 4 Clinical Studies
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Author + information
- Eugenio Stabile, MD, PhDa,∗ (geko50{at}hotmail.com),
- Gianmarco de Donato, MD, PhDb,
- Piotr Musialek, MD, PhDc,
- Koen De Loose, MDd,
- Roberto Nerla, MDe,
- Pasqualino Sirignano, MDf,
- Salvatore Chianese, MDa,
- Adam Mazurek, MDc,
- Tullio Tesorio, MDg,
- Marc Bosiers, MDd,
- Carlo Setacci, MDb,
- Francesco Speziale, MDf,
- Antonio Micari, MDd and
- Giovanni Esposito, MD, PhDa
- aDivision of Cardiology, Department of Advanced Biomedical Sciences, University of Naples “Federico II,”, Naples, Italy
- bDepartment of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
- cJagiellonian University, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
- dA.Z. Sint-Blasius, Dendermonde, Belgium
- eInterventional Cardiology Unit, Maria Cecilia Hospital, Cotignola, Italy
- fVascular and Endovascular Surgery Division, Department of Surgery “Paride Stefanini,” Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy
- gDivision of Invasive Cardiology, Clinica Montevergine, Mercogliano, Italy
- ↵∗Address for correspondence:
Dr. Eugenio Stabile, Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples “Federico II,” Naples, Italy.
Graphical abstract
Abstract
Objectives The aim of this study was to evaluate the clinical efficacy of dual-layered mesh-covered carotid stent systems (DLS) for carotid artery stenting (CAS).
Background The need to minimize the risk for plaque debris prolapsing between stent struts following CAS has resulted in the development of DLS. Small clinical studies evaluating 2 available devices, Roadsaver and CGuard, have been recently published; none of these studies is sufficiently powered to test the role of common risk factors on the occurrence of stroke at 30 days post-CAS.
Methods A search was performed of multiple electronic databases for studies larger than 100 cases of CAS with DLS. Four single-arm prospective studies were identified, and individual patient data were collected. The primary endpoint was the occurrence of stroke at 30 days; secondary endpoints were technical and procedural success, periprocedural stroke, and in-hospital and 30-day rates of death.
Results The Roadsaver and CGuard stents were used in similar proportions, and technical success was achieved in all procedures (100% [n = 556]). There were 6 periprocedural strokes (1.08%; all minor). During 30-day follow-up, there was 1 death (0.17%) from myocardial infarction and 1 additional minor stroke (0.17%). The cumulative 30-day mortality rate was 0.17%, and the incidence of stroke at 30 days was 1.25%. No predictors of stroke at 30 days could be identified.
Conclusions This meta-analysis suggests that DLS can be safely used for CAS, and their use minimizes the incremental risk related to symptomatic status and other risk factors.
Footnotes
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 30, 2017.
- Revision received June 6, 2018.
- Accepted June 26, 2018.
- 2018 American College of Cardiology Foundation
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