Long‐term results of cephalad arteries percutanoeus transluminal angioplasty with stent implantation (The CAPTAS registry)

Buszman, Piotr P.; Szymański, Radosław; Dębiński, Marcin; Milewski, Krzysztof; Król, Marek; Nowakowski, Przemysław; Kiesz, R. Stefan; Radvany, Martin G.; Wiernek, Szymon; Wiernek, Barbara K.

doi:10.1002/ccd.23391

Cited by 4 publications

(4 citation statements)

References 19 publications

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“…Severe bias presence led to study exclusion from further analysis. Finally, CAS data from103 observational and 9 randomized studies were included [ 4 , 21 , 22 , 23 , 26 , 27 , 30 , 35 , 39 , 41 , 44 , 45 , 56 , 58 , 65 , 66 , 84 , 89 , 91 , 92 , 97 , 104 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 ,…”

Section: Methodsmentioning

confidence: 99%

Clinical Outcomes of Second- versus First-Generation Carotid Stents: A Systematic Review and Meta-Analysis

Mazurek

Malinowski

Rosenfield

et al. 2022

JCM

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Background: Single-cohort studies suggest that second-generation stents (SGS; “mesh stents”) may improve carotid artery stenting (CAS) outcomes by limiting peri- and postprocedural cerebral embolism. SGS differ in the stent frame construction, mesh material, and design, as well as in mesh-to-frame position (inside/outside). Objectives: To compare clinical outcomes of SGS in relation to first-generation stents (FGSs; single-layer) in CAS. Methods: We performed a systematic review and meta-analysis of clinical studies with FGSs and SGS (PRISMA methodology, 3302 records). Endpoints were 30-day death, stroke, myocardial infarction (DSM), and 12-month ipsilateral stroke (IS) and restenosis (ISR). A random-effect model was applied. Results: Data of 68,422 patients from 112 eligible studies (68.2% men, 44.9% symptomatic) were meta-analyzed. Thirty-day DSM was 1.30% vs. 4.11% (p < 0.01, data for SGS vs. FGS). Among SGS, both Casper/Roadsaver and CGuard reduced 30-day DSM (by 2.78 and 3.03 absolute percent, p = 0.02 and p < 0.001), whereas the Gore stent was neutral. SGSs significantly improved outcomes compared with closed-cell FGS (30-day stroke 0.6% vs. 2.32%, p = 0.014; DSM 1.3% vs. 3.15%, p < 0.01). At 12 months, in relation to FGS, Casper/Roadsaver reduced IS (−3.25%, p < 0.05) but increased ISR (+3.19%, p = 0.04), CGuard showed a reduction in both IS and ISR (−3.13%, −3.63%; p = 0.01, p < 0.01), whereas the Gore stent was neutral. Conclusions: Pooled SGS use was associated with improved short- and long-term clinical results of CAS. Individual SGS types, however, differed significantly in their outcomes, indicating a lack of a “mesh stent” class effect. Findings from this meta-analysis may provide clinically relevant information in anticipation of large-scale randomized trials.

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Section: Methodsmentioning

confidence: 99%

Clinical Outcomes of Second- versus First-Generation Carotid Stents: A Systematic Review and Meta-Analysis

Mazurek

Malinowski

Rosenfield

et al. 2022

JCM

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“…However, guidelines are inconclusive 5 and the debate on carotid stent design in relation to clinical outcomes, occurrence of new MR-DWI lesions or restenosis, is ongoing. [6][7][8][9][10][11][12][13][14][15][16][17] This meta-analysis evaluated the effect of carotid stent design on early and late clinical adverse events as well as radiological outcomes in patients undergoing CAS for significant carotid artery stenosis, to allow for optimal evidence-based clinical decision making.…”

Section: Introductionmentioning

confidence: 99%

A meta-analysis of the effect of stent design on clinical and radiologic outcomes of carotid artery stenting

Vries

Meershoek

Vonken

et al. 2019

Journal of Vascular Surgery

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Objective: Procedural characteristics, including stent design, may influence the outcome of carotid artery stenting (CAS). A thorough comparison of the effect of stent design on outcome of CAS is thus warranted to allow for optimal evidence-based clinical decision making. This study sought to evaluate the effect of stent design on clinical and radiological outcomes of CAS.Methods: A systematic search was conducted in MEDLINE, Embase, and Cochrane databases in May 2018. Included were articles reporting on the occurrence of clinical short-and long-term major adverse events (MAE, any stroke or death) or radiological adverse events (new ischemic lesions on postprocedural magnetic resonance diffusion-weighted imaging (MR-DWI), restenosis or stent fracture) in different stent designs used to treat carotid artery stenosis.Random effects models were used to calculate combined overall effect sizes. Meta-regression was performed to identify the effect of specific stents on MAE rates. Results: From 2,654 unique identified articles, two randomized controlled trials and 66 cohort studies were eligible for analysis (including 46,728 procedures). Short-term clinical MAE rates were similar for patients treated with open cell versus closed cell or hybrid stents. Use of Acculink stent was associated with a higher risk of MAE compared to Wallstent (RR: 1.51, p=0.03), as was true for use of Precise stent versus Xact stent (RR: 1.55, p<0.001). Long-term clinical MAE rates were similar for open versus closed cell stents. Use of open cell stents predisposed to a 25% higher chance (RR: 1.25; p=0.03) of developing postprocedural new ischemic lesions on MR-DWI. No differences were observed in incidence of restenosis, stent fracture, or intraprocedural hemodynamic depression with respect to different stent design. [Type here] Conclusions: Stent design does not affect short-or long-term clinical MAE rates in patients undergoing CAS. Furthermore, the division in open and closed cell stent design might conceal true differences in single stent efficacy. Nevertheless, open cell stenting resulted in a significantly higher number of MR-DWI-detected subclinical postprocedural new ischemic lesions compared with closed cell stenting. An individualized patient data meta-analysis,including future studies with prospective homogenous study design, is required to adequately correct for known risk factors and provide definite conclusions with respect to carotid stent design for specific subgroups.

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“…Low incidence of adverse events after stenting has been shown in several single and multicenter clinical practice studies [2][3][4][5][6]. One of the latest trials to date, Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) demonstrated comparable outcome rates after stenting and surgery.…”

Section: Introductionmentioning

confidence: 99%

“…4,2 %. Věk ≥ 80 let zvyšoval riziko vzniku CMP/úmrtí z KV příčin/IM do jednoho roku (OR 4,41; 95% CI 1,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)36; p = 0,04). Závěry: Studie prokázala přijatelné klinické výsledky pacientů s CAS a vysokou incidencí přidružených onemocnění, kteří byli léčeni intenzivní farmakoterapií.…”

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Carotid artery stenting outcomes in high-risk patients receiving best medical therapy: results from a single high-volume interventional cardiology practice

et al. 2016

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Implantace stentů do karotických tepen (carotid artery stenting, CAS) se v současnosti ve velkém měřítku používá v léčbě stenózy karotických tepen. Klinické studie z poslední doby prokázaly nízkou incidenci příhod po CAS. Tato studie hodnotí 30denní a roční výsledky pacientů léčených pro CAS intenzivní farmakoterapií na pracovišti provádějícím vysoké počty perkutánních koronárních intervencí ročně. Metoda: V období od ledna 2011 do prosince 2013 byla CAS provedena celkem u 184 pacientů. Mimo protidestičkové léčby byla prováděna i intenzivní antihypertenzní léčba spolu s vysoce intenzivní terapií statiny a léčbou zaměřenou na normalizaci srdeční frekvence. Pacienti byli stratifi kováni podle věku a symptomů. Výsledky: Většina pacientů (86,4 %) splňovala alespoň jedno kritérium vysokého operačního rizika. Výkon byl úspěšný v 98,4 % případů. Třicetidenní a roční incidence cévních mozkových příhod (CMP) byla 4,1 %, resp. 4,5 %. Po 30 dnech byla kombinovaná incidence CMP/úmrtí z kardiovaskulárních (KV) příčin/infarktu myokardu (IM) 5,8 %; po jednom roce dosáhla hodnoty 10,9 %. Třicetidenní incidence CMP/úmrtí z KV příčin u asymptomatických a symptomatických pacientů byla 5,4 %, resp. 4,2 %. Věk ≥ 80 let zvyšoval riziko vzniku CMP/úmrtí z KV příčin/IM do jednoho roku (OR 4,41; 95% CI 1,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)36; p = 0,04). Závěry: Studie prokázala přijatelné klinické výsledky pacientů s CAS a vysokou incidencí přidružených onemocnění, kteří byli léčeni intenzivní farmakoterapií. Incidence příhod u symptomatických pacientů nepřesáhla rozmezí uváděné v guidelines jako doporučené, zatímco u asymptomatických pacientů byla incidence zvýšená.

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Long‐term results of cephalad arteries percutanoeus transluminal angioplasty with stent implantation (The CAPTAS registry)

Abstract: CAS is safe and successful procedure with low early and long-term adverse events. Special attention should be put on patients with bilateral and left ICA stenoses. If possible, longer stents should be applied.

Cited by 4 publications

References 19 publications

Clinical Outcomes of Second- versus First-Generation Carotid Stents: A Systematic Review and Meta-Analysis

Clinical Outcomes of Second- versus First-Generation Carotid Stents: A Systematic Review and Meta-Analysis

A meta-analysis of the effect of stent design on clinical and radiologic outcomes of carotid artery stenting

Carotid artery stenting outcomes in high-risk patients receiving best medical therapy: results from a single high-volume interventional cardiology practice

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