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Original research
Reduction of cerebral DWI lesion burden after carotid artery stenting using the CASPER stent system
  1. Erasmia Broussalis1,2,
  2. Christoph Griessenauer2,3,
  3. Sebastian Mutzenbach1,
  4. Slaven Pikija1,
  5. Hendrik Jansen4,
  6. Valdo Stevanovic5,
  7. Monika Killer-Oberpfalzer1,2
  1. 1 Department of Neurology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
  2. 2 Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
  3. 3 Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
  4. 4 Department of Neuroradiology, Paracelsus Medical University, Nuremberg, Germany
  5. 5 Department of Radiology/Section Neuroradiology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
  1. Correspondence to Dr Erasmia Broussalis, Department of Neurology/Institute of Neurointervention, Paracelsus Medical University, Salzburg 5020, Austria; e.broussalis{at}


Introduction Despite various measures to protect against distal embolization during carotid artery stenting (CAS), periprocedural ischemic lesions are still encountered.

Objective To evaluate the periprocedural cerebral diffusion weighted imaging (DWI) lesion burden after CASPER stent placement.

Methods Patients who underwent CAS using the CASPER stent system were reviewed. Degrees of carotid stenosis and plaque configuration were determined. All patients were pretreated with dual antiplatelet agents and cerebral pre- and postprocedural MRI was obtained. All CAS procedures were performed by a single operator.

Results A total of 110 patients with severe carotid artery stenosis (median degree of stenosis 80%, median length of stenosis 10 mm) were treated with CAS. Hypoechogenic or heterogeneous, mostly hypoechogenic, plaques were documented in 48.6% (52/107) of patients. Carotid ulceration was present in 15.9% (17/107). Postprocedurally, 7.3% (8/110) of patients were found to have ischemic DWI lesions. They were asymptomatic in all patients. Follow-up at 90 days was available in 88.2% (97/110) of patients with excellent functional outcome (modified Rankin Scale score 0–1) in 95.9% (93/97).

Conclusion Carotid artery stenting using the new CASPER stent in combination with a distal embolic protection device is safe and results in a lower rate of periprocedural DWI lesion burden compared with reported results for historic controls.

  • DWI lesion
  • carotid stent
  • CAS

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  • Contributors All authors gave their final approval for publication. EB: data collection, manuscript preparation. CG, SM: manuscript preparation and critical review. SP: data manuscript preparation, statistics and critical review. HJ: data manuscript preparation and critical review. VS: data collection, image review. MK-O: study design, manuscript preparation and critical review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests The senior author of this study receives independent research grant funding from Microvention/Terumo.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No data from this study are available elsewhere.