TY - JOUR
T1 - A multi-center study of the MicroNET-covered stent in consecutive patients with acute carotid-related stroke
T2 - SAFEGUARD-STROKE
AU - Tekieli, Lukasz
AU - Afanasiev, Andrey
AU - Mazgaj, Maciej
AU - Borodetsky, Vladimir
AU - Sievert, Kolja
AU - Ruzsa, Zoltan
AU - Knapik, Magdalena
AU - Širvinskas, Audrius
AU - Mazurek, Adam
AU - Dzierwa, Karolina
AU - Sanczuk, Thomas
AU - Mosenko, Valerija
AU - Urbanczyk-Zawadzka, Malgorzata
AU - Trystula, Mariusz
AU - Paluszek, Piotr
AU - Wiewiorka, Lukasz
AU - Stefaniak, Justyna
AU - Pieniazek, Piotr
AU - Slautaite, Inga
AU - Kwiatkowski, Tomasz
AU - Mackevičius, Arturas
AU - Teitcher, Michael
AU - Sievert, Horst
AU - Grunwald, Iris Q.
AU - Musialek, Piotr
N1 - Publisher Copyright:
© 2024 Termedia Publishing House Ltd.. All rights reserved.
PY - 2024/6/30
Y1 - 2024/6/30
N2 - Introduction: Acute carotid-related stroke (CRS), with its large thrombo-embolic load and large volume of affected brain tissue, poses significant management challenges. First generation (single-layer) carotid stents fail to insulate the athero-thrombotic material; thus they are often non-optimized (increasing thrombosis risk), yet their use is associated with a significant (20-30%) risk of new cerebral embolism. Aim: To evaluate, in a multi-center multi-specialty investigator-initiated study, outcomes of the MicroNET-covered (cell area ≈ 0.02-0.03 mm2) carotid stent (CGuard, InspireMD) in consecutive CRS patients eligible for emergency recanalization. Treatment, other than study device use, was according to center/operator routine. Material and methods: Seventy-five patients (age 40-89 years, 26.7% women) were enrolled in 7 interventional stroke centers. Results: The median Alberta Stroke Program Early CT Score (ASPECTS) was 9 (6-10). Study stent use was 100% (no other stent types implanted); retrograde strategy predominated (69.2%) in tandem lesions. Technical success was 100%. Post-dilatation balloon diameter was 4.0 to 8.0 mm. 89% of patients achieved final modified Thrombolysis in Cerebral Infarction (mTICI) 2b-c/3. Glycoprotein IIb/IIIa inhibitor use as intraarterial (IA) bolus + intravenous (IV) infusion was an independent predictor of symptomatic intracranial hemorrhage (OR = 13.9, 95% CI: 5.1-84.5, p < 0.001). The mortality rate was 9.4% in-hospital and 12.2% at 90 days. Ninety-day mRS0-2 was 74.3%, mRS3-5 13.5%; stent patency was 93.2%. Heparin-limited-to-flush predicted patency loss on univariate (OR = 14.3, 95% CI: 1.5-53.1, p < 0.007) but not on multivariate analysis. Small-diameter balloon/absent post-dilatation was an independent predictor of stent patency loss (OR = 15.2, 95% CI: 5.7-73.2, p < 0.001). Conclusions: This largest to-date study of the MicroNET-covered stent in consecutive CRS patients demonstrated a high acute angiographic success rate, high 90-day patency and favorable clinical outcomes despite variability in procedural strategies and pharmacotherapy.
AB - Introduction: Acute carotid-related stroke (CRS), with its large thrombo-embolic load and large volume of affected brain tissue, poses significant management challenges. First generation (single-layer) carotid stents fail to insulate the athero-thrombotic material; thus they are often non-optimized (increasing thrombosis risk), yet their use is associated with a significant (20-30%) risk of new cerebral embolism. Aim: To evaluate, in a multi-center multi-specialty investigator-initiated study, outcomes of the MicroNET-covered (cell area ≈ 0.02-0.03 mm2) carotid stent (CGuard, InspireMD) in consecutive CRS patients eligible for emergency recanalization. Treatment, other than study device use, was according to center/operator routine. Material and methods: Seventy-five patients (age 40-89 years, 26.7% women) were enrolled in 7 interventional stroke centers. Results: The median Alberta Stroke Program Early CT Score (ASPECTS) was 9 (6-10). Study stent use was 100% (no other stent types implanted); retrograde strategy predominated (69.2%) in tandem lesions. Technical success was 100%. Post-dilatation balloon diameter was 4.0 to 8.0 mm. 89% of patients achieved final modified Thrombolysis in Cerebral Infarction (mTICI) 2b-c/3. Glycoprotein IIb/IIIa inhibitor use as intraarterial (IA) bolus + intravenous (IV) infusion was an independent predictor of symptomatic intracranial hemorrhage (OR = 13.9, 95% CI: 5.1-84.5, p < 0.001). The mortality rate was 9.4% in-hospital and 12.2% at 90 days. Ninety-day mRS0-2 was 74.3%, mRS3-5 13.5%; stent patency was 93.2%. Heparin-limited-to-flush predicted patency loss on univariate (OR = 14.3, 95% CI: 1.5-53.1, p < 0.007) but not on multivariate analysis. Small-diameter balloon/absent post-dilatation was an independent predictor of stent patency loss (OR = 15.2, 95% CI: 5.7-73.2, p < 0.001). Conclusions: This largest to-date study of the MicroNET-covered stent in consecutive CRS patients demonstrated a high acute angiographic success rate, high 90-day patency and favorable clinical outcomes despite variability in procedural strategies and pharmacotherapy.
KW - carotid artery stenting
KW - carotid stenosis
KW - carotid-related stroke
KW - cerebral protection devices
KW - CGuard
KW - clinical outcomes
KW - mechanical reperfusion
KW - mechanical thrombectomy
KW - MicroNET-covered stent
KW - stent optimization
KW - stroke endovascular treatment
UR - http://www.scopus.com/inward/record.url?scp=85197288799&partnerID=8YFLogxK
U2 - 10.5114/aic.2024.140963
DO - 10.5114/aic.2024.140963
M3 - Article
C2 - 39022700
AN - SCOPUS:85197288799
SN - 1734-9338
VL - 20
SP - 172
EP - 193
JO - Postepy w Kardiologii Interwencyjnej
JF - Postepy w Kardiologii Interwencyjnej
IS - 2
M1 - 76
ER -