Introduction A new generation of carotid artery stents that use a dual micromesh layer to reduce embolic events during carotid artery stenting has recently been introduced. We aimed to analyze the effectiveness and safety of the new Casper-RX stent in patients experiencing acute ischemic stroke with large vessel intracranial occlusion associated with a tandem lesion (another carotid occlusion or severe stenosis).
Methods We retrospectively analyzed all consecutive patients treated with carotid Casper-RX stents from our stroke registry. We analyzed clinical, angiographic, and neuroimaging data. Endpoints included acute intra-stent thrombus formation, stent occlusion prior to hospital discharge, 3 month modified Rankin Scale score (mRS), and symptomatic intracranial hemorrhage.
Results 21 patients were included: 10 patients had tandem carotid occlusions and 11 patients had severe carotid stenosis, 8 of whom had a hemodynamically significant stenosis. We observed acute in-stent thrombus formation in 11 patients. No stent occlusion occurred prior to hospital discharge. We report no stroke recurrence at 3 months but symptomatic intracranial hemorrhage in two patients. mRS score at 3 months was 0–2 (favorable) for 15 patients (71%), 3–5 for 3 patients, and 6 for 3 patients.
Conclusions In the present series, we frequently observed clot formation during the procedure with Casper-RX stents, which required periprocedural intravenous infusion of anticoagulant and antiplatelet treatment. This motivated us, in the absence of a prospective randomized controlled study demonstrating the non-inferiority of micromesh dual layer stents compared with the single layer design, to discontinue using this stent type in acute stroke requiring carotid angioplasty.
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Contributors BB contributed to the conception and design of the work, analysis and interpretation of the data, and drafting the paper. FP contributed to acquisition of the data and critical revision. PJM contributed to acquisition of the data and critical revision. SDH contributed to critical revision. LV contributed to analysis and interpretation of the data, and critical revision. PM contributed to the conception and design of the work, acquisition of the data, and critical revision. GS contributed to the conception and design of the work, and critical revision. All authors approved the final version to be published.
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 PM: speaker and consulting fees from Medtronic, Steering committee of PROMISE (Penumbra). All this support goes to the institution and is used for stroke education and research. The other authors report no conflicts.
Ethics approval The Swiss ethics committee (Canton of Vaud) approved collection, analysis and publication of data from ASTRAL registry.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Additional unpublished data are available upon request.
Patient consent for publication Not required.