Department of Neuroradiology, Bonn University Hospital, Venusberg-Campus1, Gebäude 81, 53127, Bonn, Germany.
Department of Neurology, Bonn University Hospital, Bonn, Germany.
Neuroradiology. 2024 Sep;66(9):1635-1644. doi: 10.1007/s00234-024-03397-w. Epub 2024 Jun 7.
Double-layer design carotid stents have been cast in a negative light since several investigations reported high rates of in-stent occlusions, at least in the acute setting of tandem occlusions. CGuard is a new generation double-layered stent that was designed to prevent periinterventional embolic events. The aim of this study was to analyze the safety and efficacy of the CGuard in emergent CAS and for the acute treatment of tandem occlusions in comparison with the single-layer Carotid Wallstent (CWS) system.
All patients who underwent CAS with CGuard or CWS after intracranial mechanical thrombectomy (MT) between 11/2018 and 12/2022 were identified from our local thrombectomy registry. Clinical, interventional and neuroimaging data were analyzed. Patency of the stent was assessed within 72 h. Intracranial hemorrhage and modified Rankin score (mRS) at discharge were the main endpoints.
In total, 86 stent procedures in 86 patients were included (CWS: 44, CGuard: 42). CGuard had a lower, but not statistically significant rate (p = 0.431) of in-stent occlusions (n = 2, 4.8%) when compared to the CWS (n = 4, 9.1%). Significant in-stent stenosis was found in one case in each group. There was no statistically significant difference in functional outcome at discharge between the two groups with a median mRS for CGuard of 2 (IQR:1-5) vs. CWS 3 (IQR:2-4).
In our series, the rate of in-stent occlusions after emergent CAS was lower with the dual-layer CGuard when compared to the monolayer CWS. Further data are needed to evaluate the potential benefit of the design in more detail.
由于几项研究报告称在串联闭塞的急性情况下，支架内闭塞发生率很高，双层设计的颈动脉支架一直受到负面评价。CGuard 是一种新一代的双层支架，旨在预防介入治疗期间的栓塞事件。本研究旨在分析 CGuard 在紧急颈动脉内膜切除术（CAS）中的安全性和疗效，并与单层颈动脉 Wallstent（CWS）系统比较，用于急性治疗串联闭塞。
从我们当地的血栓切除术登记处确定了 2018 年 11 月至 2022 年 12 月期间接受颅内机械血栓切除术（MT）后接受 CGuard 或 CWS 行 CAS 的所有患者。分析了临床、介入和神经影像学数据。在 72 小时内评估支架的通畅性。颅内出血和改良 Rankin 评分（mRS）为出院的主要终点。
共纳入 86 例 86 例支架手术（CWS：44 例，CGuard：42 例）。与 CWS（n=4，9.1%）相比，CGuard 的支架内闭塞发生率较低，但无统计学意义（p=0.431）（n=2，4.8%）。两组均有 1 例支架内明显狭窄。两组出院时的功能结局无统计学差异，CGuard 的中位 mRS 为 2（IQR：1-5），CWS 为 3（IQR：2-4）。
在我们的系列中，与单层 CWS 相比，紧急 CAS 后双层 CGuard 的支架内闭塞率较低。需要进一步的数据来更详细地评估设计的潜在益处。
