Use of Double-Layer Carotid Stents is Associated with Improved Patient Survival and Lower Neurological Complications: A Single-Center Retrospective Observational Study
Kipras MikelisMarius KurminasGivi LengvenisRadvilas JančiauskasNerijus MisonisPovilas BudrysRokas ŠerpytisAndrius Berūkštis
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Abstract:
Background/Objectives: Dual-layer stents (DLS) with micromesh technology may offer better protection from plaque protrusion compared to single-layer stents (SLS), but little data are available. The aim of this study is to compare clinical outcomes of elective carotid artery stenting for asymptomatic and symptomatic patients treated for primary CAS with DLS or SLS in a high-volume center. Methods: This study is a single-center retrospective cohort study and included patients who underwent elective CAS between December 2006 and September 2023. The final analysis included patient baseline characteristics, postoperative complications and patient outcomes. Results: A total of 573 patients underwent elective carotid artery stenting in the study period. Most of the 573 patients undergoing CAS were male (62.5%), and the median age of patients at the time of CAS was 70 years. Of the 573 eligible patients, 43.5% (n = 249) were asymptomatic and 56.4% (n = 323) were symptomatic. Analyzing neurological complications, it was found that the only factor that had a statistically significant effect was the type of stent used. Patients who had a carotid stenting procedure using a single-layer carotid stent had statistically significantly more periprocedural neurological complications (8.3% (n = 35)) than the double-mesh stent group (2% (n = 3)), mostly due to more transient ischemic attacks in the single-layer stent group (4% (n = 17)) compared to the double-mesh group (0.7% (n = 1)). Conclusions: The use of carotid double-layer stents is associated with a low rate of periprocedural and postprocedural events.Keywords:
Single Center
Carotid stenting
Carotid stenting has become an accepted alternative in patients with carotid stenosis. The purpose of this article is to review the relevant trials, describe the different devices available for stenting, the devices for cerebral protection, as well as describe techniques and tricks for successful carotid artery stenting. Understanding how to appropriately preoperatively evaluate patients and intra- and postoperative procedures, carotid artery stenting can be a safe procedure.
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This chapter contains sections titled: Background Important Concepts and Considerations Cerebral Protection Devices Indications and Contra-indications Carotid Plaque Characteristics and Vascular Anatomy Self-expanding Carotid Stents Step-by-Step Technique of Carotid Stenting Case Histories Carotid Stenting Complications Future Directions Tailored Approach to CAS: Scientific Evidence Acknowledgments References
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Carotid artery stenting (CAS) is a complex endovascular procedure that may be an alternative for carotid endarterectomy in selected patients. This paper provides an overview of the anatomical and lesion characteristics that are related to an increase in complications with CAS procedures, in order to provide criteria to select patients that will benefit most from CAS.
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