Potential of new generation double-layer micromesh stent for carotid artery stenting in patients with unstable plaque ∼ A preliminary result using OFDI analysis

Abstract Background One of the disadvantages of carotid artery stenting (CAS) is high incidence of distal embolism (DE) during or after the procedure. It has been reported that unstable plaque cases are at high risk of DE and plaque protrusion (PP) after stent placement which will become a cause of...

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Bibliographic Details
Published in:World neurosurgery 2017-09, Vol.105, p.321-326
Main Authors: Yamada, Kiyofumi, M.D., Ph.D, Yoshimura, Shinichi, M.D., Ph.D, Miura, Masatomo, M.D, Kanamaru, Takuya, M.D, Shindo, Seigo, M.D, Uchida, Kazutaka, M.D, Shirakawa, Manabu, M.D., Ph.D, Shibuya, Masahiko, M.D., Ph.D, Imanaka, Takahiro, M.D., Ph.D, Ishihara, Masaharu, M.D., Ph.D, Masuyama, Tohru, M.D., Ph.D, Ishikura, Reiichi, M.D., Ph.D, Kawasaki, Masanori, M.D., Ph.D
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Angiography, Digital Subtraction
Carotid artery stenosis
Carotid artery stenting
Carotid Stenosis - surgery
Female
Humans
Magnetic Resonance Imaging
Male
Micromesh stent
Middle Aged
Neurosurgery
Optical frequency domain imaging
Plaque protrusion
Plaque, Atherosclerotic - diagnostic imaging
Plaque, Atherosclerotic - etiology
Plaque, Atherosclerotic - surgery
Retrospective Studies
Stents - adverse effects
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Summary:Abstract Background One of the disadvantages of carotid artery stenting (CAS) is high incidence of distal embolism (DE) during or after the procedure. It has been reported that unstable plaque cases are at high risk of DE and plaque protrusion (PP) after stent placement which will become a cause of post procedural ischemic complications. Objective The purpose of this study was to compare the rate and size of PP between CASPER stent which is a new generation double-layer micromesh stent and conventional stents detected by optical frequency domain imaging (OFDI) and to evaluate the efficacy of CAS with CASPER stent for cases with unstable plaque. Methods Forty-six consecutive patients with unstable plaque defined as magnetic resonance imaging undergoing CAS with OFDI image acquisition were enrolled in this study. Cross-sectional OFDI images within the stented segments were evaluated at 0.125mm intervals and compared the rate and size of PP between CASPER stent and conventional stents. Results CASPER stent was used in 9 patients. No procedural complications occurred. With OFDI analysis, presence of PP was apparently lower in CASPER stent group than conventional stents group (44% vs 88%, p=0.022). Also, mean PP area was significantly smaller in CASPER stent group than conventional stents group (Mean PP area: 0.013 ± 0.034 mm2 vs 0.057 ± 0.09 mm2 , p=0.006). Conclusion Using OFDI evaluation after CAS, the degree of PP was significantly smaller in CASPER stent than conventional stents. This result indicates new insights of CAS for the treatment of carotid artery stenosis with unstable plaque.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2017.05.171