Thursday, June 6, 2019

Does the Type of Carotid Stent, Cerebral Protection Matter During Carotid Artery Stenting in High-Risk Patients?

I still don't understand why you would medically need to stent a carotid artery at all if the Circle of Willis is complete. (Unless the whole point is revenue and profit generation) It would seem to make more sense to just close it up and prevent problems from there.  My right carotid artery has been closed for the past 10 years and I cognitively function quite well with no episodes of fainting. But I'm not medically trained and thus can't even ask these simple questions. 

And this problem:

Plaque Protrusion Tied to Stroke in Carotid Stenting 3% rate

 

Does the Type of Carotid Stent, Cerebral Protection Matter During Carotid Artery Stenting in High-Risk Patients?

MILAN, Italy -- May 28, 2019 -- In patients with high-risk lipid-rich plaque undergoing carotid artery stenting, using the Use the MoMa ultra proximal cerebral protection device plus the double-mesh Roadsaver (RS) stent seems to be a promising tool in limiting embolic risks, and outperforms the single-mesh Carotid Wallstents (CW), according to a study presented here at the 5th European Stroke Organisation Conference (ESOC).

“The role of the stent type during carotid artery stenting is unclear,” said Luigi Caputi, MD, Fondazione IRCCS ‘C. Besta’ Neurological Institute, Milan, Italy. However, “the newer double-mesh carotid stents might reduce embolic complication.”

The researchers compared the safety and efficacy of RS and CW stents during carotid artery stenting in 104 patients with lipid-rich plaques. All patients in the study had unilateral de-novo carotid artery stenosis (symptomatic or asymptomatic) with high lipid-plaque composition.

Both stents were randomly tested with FilterWire and MO.MA cerebral protection, and patients were randomised to stenting with MoMa plus CW (n = 25), MoMa plus RS (n = 27), FilterWire plus RS (n = 27) or FilterWire plus CW (n = 25).

The primary endpoint was the number of microembolic signals (MES) by transcranial Doppler ultrasound.

When comparing the FilterWire with MoMa, MoMa significantly reduced MES (P < .0001) during target vessel cannulation, lesion wiring, lesion stent crossing, stent deployment, and stent dilation.

When comparing RS with CW, MES were significantly lower with RS during stent deployment, stent dilation, device retrieval/deflation (P = .031).

MoMa plus RS performed significantly better than MoMa plus CW (P = .043).

There were no significant differences for in-hospital and 30-day major adverse cardiac and cerebrovascular events and vascular complications, which included 1 retinal embolism, 1 minor stroke (premature opening of MoMa balloon [operator error]), and 1 death (acute rupture of iliac aneurysm).

“There were no significant differences in restenosis rates,” said Dr. Caputi.

[Presentation title: Randomized Study Comparing the Type of Carotid Stent and Cerebral Protection During Carotid Artery Stenting in Patients With High-Risk Plaque]

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