Micronet-covered carotid artery stent provides superior cerebral protection after stenting: Study

The aim of this study was to compare procedure-related ipsilateral cerebral embolism with a conventional (Acculink, Abbott Vascular) versus a MicroNet-covered (CGuard, InspireMD) stent in carotid artery stenting (CAS).

The MicroNet-covered stent may reduce periprocedural cerebral embolism in CAS, but level 1 evidence is lacking.

A total of 100 consecutive patients were randomized 1:1 to filter-protected CAS using the Acculink or the CGuard device. The study was powered for its primary endpoint of at least 50% reduction in ipsilateral diffusion-weighted magnetic resonance imaging lesion average volume 48 hours postprocedure (blinded external core laboratory analysis).

The Results of the study are as follows:

The baseline characteristics of the study groups were similar.

Eighty-two (total volume = 18,212 mm3) diffusion-weighted magnetic resonance imaging postprocedural cerebral lesions occurred in 26 Acculink-treated patients and 45 lesions (total volume = 3,930 mm3; 78.4% reduction) in 25 CGuard-treated patients.

New cerebral lesion average volume was 171 mm3 vs 73 mm3 per affected patient and 222 mm3 vs 84 mm3 per lesion (Acculink vs CGuard). In lesion-affected patients, the average sum of lesion volumes was 701 mm3 vs 157 mm3

The Acculink significantly increased the risk for multiple (≥5) cerebral lesions

At 30 days, new permanent (fluid-attenuated inversion recovery) lesion prevalence was 3:1 with total permanent lesion volume 7,474 mm3 vs 574 mm3

There were 6 vs 0 new ipsilateral lesions and 2 versus 0 strokes.

Thus, the researchers concluded that the MicroNet-covered stent significantly reduced periprocedural and abolished postprocedural cerebral embolism in relation to a conventional carotid stent. This is consistent with the MicroNet-covered stent's sustained embolism prevention, translating into cerebral protection not only during but also after CAS. The present findings may influence decision making in carotid revascularization.

Reference:

Randomized Controlled Trial of Conventional Versus MicroNet-Covered Stent in Carotid Artery Revascularization by Andrey Karpenko et al. published in the JACC journal.

J Am Coll Cardiol Intv. 2021 Nov, 14 (21) 2377–2387