Its unique dual-layer structure may help reduce thromboembolic complications, researchers say.
Casper, a novel stent designed to prevent embolic release, can successfully treat carotid artery stenosis without triggering severe neurological sequelae, according to a retrospective analysis of registry data published online January 11, 2018, ahead of print in the Journal of NeuroInterventional Surgery.
Self-expanding stents represent the current standard of care for carotid artery stenting, note Sebastian J. Mutzenbach, MD (Paracelsus Medical University, Salzburg, Austria), and colleagues. “[T]he stent frame, with its characteristic design and radial force,” they write, “provides an intrinsic antiembolic effect: the stent struts seek to prevent escape of the disrupted plaque through the interstices while maintaining the caliber of the vessel wall.”
The Casper stent (MicroVention) improves on this design via “a braided-nitinol and dual-layer micromesh design, which allows optimal conformability and wall apposition, to prevent plaque prolapse, with the aim of lowering the periprocedural stroke risk,” they say.
The authors conducted a retrospective analysis of prospectively collected data on 138 patients (median age 71 years; 25.4% women) who received Casper for symptomatic and asymptomatic carotid artery stenosis between January 2014 and February 2017. Symptomatic patients, who made up 42.7% of the cohort, had stenosis of > 70% of vessel diameter or > 50% diameter with ulceration. Asymptomatic patients had > 80% stenosis at the carotid bifurcation or in the proximal internal carotid artery. For all procedures, a distal embolic protection device was used.
No Visible Emboli Captured
The primary endpoint was the 90-day composite incidence of major adverse neurological events, defined as minor stroke, major stroke, or death, by independent neurological assessment.
In all cases, stent deployment was successful, and there were no documented technical failures. There were no adverse neurological events or deaths by 90 days. One thromboembolic occlusion of a small distal branch of the anterior cerebral artery occurred during the procedure, but this resolved with systemic administration of recombinant tPA.
“There were no visible emboli captured by the protection device,” write the authors. “Significant residual stenosis could be excluded as a sign of technical success. Only 14.5% of patients had residual stenosis (30-40%).”
New ischemic lesions were seen in 6.5% of patients on postprocedure cerebral MRI, but all were clinically silent.
Mutzenbach et al conclude that treatment of carotid artery stenosis with Casper “was safe and effective in our series, with thromboembolic complications and stroke events reduced, potentially due to its unique dual-layer structure.”
Source:
Mutzenbach SJ, Millesi K, Roesler C, et al. The Casper Stent System for carotid artery stenosis. J NeuroInterv Surg. 2018;Epub ahead of print.
Disclosures:
Mutzenbach reports no relevant conflicts of interest.
