The Casper carotid artery stent: a unique all metal micromesh stent designed to prevent embolic release

Abstract

The Casper has been an excellent stent for the treatment of internal carotid artery stenosis and its internal micromesh layer has been effective in preventing plaque prolapse. It provides the flexibility of large cell stents and the inner layer provides maximum protection against plaque prolapse.

Comparison of different carotid stent designs in endovascular therapy of severe carotid artery stenosis

“…Our postprocedural residual stenoses were similar to those reported by other dual-layer stent studies. 11 Furthermore, we had no deployment failure, and no other complications such as dissections or vessel perforations.…”

“…As a representative of a DLCS, we used the CASPER stent system (MicroVention Inc., Tustion, California, USA)-a self-expanding, nitinol-based, double-layer micromesh stent system with closed cell structure and very small stent cell size area of 390-900 mm 2 -was used. 9,11 As a representative of an HCS, we used the Cristallo Ideale stent system (Medtronic, Minneapolis, Minnesota, USA)-a self-expanding hybrid stent system that consists of closed cell design in the central part and open cell design in the proximal and distal part of the stent combining the advantages of both stent cell designs-open and closed mesh stents-was used. 14 The choice of the carotid stent system was firstly at the discretion of the treating neurointerventionalist and secondly also depended on the availability of the novel DLCS, which became more frequent over the time.…”

“…[6][7][8][9] A small study showed that plaque protrusion rate-a potential source of distal emboli-is significantly lower in new-generation double-layer stents compared to conventional carotid stents. 10 Self-expending nitinol double-layer micromesh carotid stent systems, designed to prevent periprocedural embolic events 9,11 belong to the latest generation of carotid stent systems and have been effective in periprocedural stroke prevention. 12 But there is evidence that DLCS have a higher reocclusion rate in emergent carotid stenting compared to a monolayer stent system.…”

The Casper Stent System for carotid artery stenosis

“…Wissgott et al presented the first clinical results of the CSS implantation in 12 patients and found it to be safe, without any ischemic complications 22. Diaz et al showed that the CSS is an excellent treatment option for carotid artery stenosis without procedure related complications, but 2 of 19 patients suffered delayed ischemic strokes 23. However, there are also experiences in larger patient cohorts with the micromesh Roadsaver carotid artery stent, which provides the safety and efficacy of this system with a low percentage of plaque prolapse and good short term clinical outcome 24 25…”

Carotid stenosis – basing treatment on individual patients’ needs. Optimal medical therapy alone or accompanied by stenting or endarterectomy

“…Kotsugi et al [58] found an incidence of plaque protrusion with CAS of 2.9 %, strongly associated with ischaemic stroke. The mesh should retain particles ≥ 200 μm, which potentially induce brain damage [59,60]. Mesh-covered stents could possibly close the safety gap caused by removal of the protection system up to complete endotheliasation.…”