Department of Radiology, Interventional Neuroradiology Unit, Lausanne University Hospital, Lausanne, Switzerland.
University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland.
J Neurointerv Surg. 2019 Aug;11(8):772-774. doi: 10.1136/neurintsurg-2018-014425. Epub 2018 Dec 4.
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).
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.
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.
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.
最近推出了一种新一代颈动脉支架，它使用双层微网来减少颈动脉支架置入术中的栓塞事件。我们旨在分析新型 Casper-RX 支架在伴有串联病变（另一个颈动脉闭塞或严重狭窄）的大血管颅内闭塞的急性缺血性脑卒中患者中的有效性和安全性。
我们从我们的卒中登记处回顾性分析了所有连续接受颈动脉 Casper-RX 支架治疗的患者。我们分析了临床、血管造影和神经影像学数据。终点包括急性支架内血栓形成、支架在出院前闭塞、3 个月改良 Rankin 量表评分（mRS）和症状性颅内出血。
共纳入 21 例患者：10 例患者有串联颈动脉闭塞，11 例患者有严重颈动脉狭窄，其中 8 例有血流动力学意义的狭窄。我们观察到 11 例患者发生急性支架内血栓形成。支架在出院前未发生闭塞。我们报告 3 个月时无卒中复发，但有 2 例发生症状性颅内出血。3 个月时 mRS 评分为 0-2（有利）的患者为 15 例（71%），3-5 的患者为 3 例，6 的患者为 3 例。
在本系列中，我们经常观察到 Casper-RX 支架置入术中形成血栓，这需要在围手术期静脉输注抗凝和抗血小板治疗。在没有前瞻性随机对照研究证明双层微网支架与单层设计相比不劣效的情况下，这促使我们停止在需要颈动脉血管成形术的急性卒中中使用这种支架类型。
