The Casper Stent System for carotid artery stenosis

Mutzenbach, Sebastian; Millesi, Katharina; Roesler, Cornelia; Broussalis, Erasmia; Pikija, Slaven; Sellner, Johann; Machegger, Lukas; Griessenauer, Christoph J.; Killer‐Oberpfalzer, Monika

doi:10.1136/neurintsurg-2017-013583

Cited by 25 publications

(13 citation statements)

References 27 publications

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“…Under consideration of the previously published results concerning thrombus formation and occlusion of SLS and a very low rate of thromboembolic events and stent occlusions in patients undergoing scheduled CAS using a CASPER stent,6 17 we believe that the higher rate of CASPER stent occlusion reported by Yilmaz et al and Bartolini et al might potentially be attributed to other factors which have not yet been investigated (eg, blood velocity profile, vascular anatomy (ie, tortuosity of the common and internal carotid artery), blood coagulation parameters, and residual stenosis after stenting).…”

Section: Discussionmentioning

confidence: 82%

Acute thromboses and occlusions of dual layer carotid stents in endovascular treatment of tandem occlusions

Pfaff

Maurer

Müller-Thies-Broussalis

et al. 2019

J NeuroIntervent Surg

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PurposeTo evaluate the occurrence and risk factors of acute in-stent thrombosis or stent occlusion in patients with tandem occlusions receiving intracranial mechanical thrombectomy and emergent extracranial internal carotid artery stenting with a dual layer carotid stent.MethodsMulticenter retrospective data collection and analysis of stroke databases of seven comprehensive stroke centers from three European countries.ResultsOverall, 160 patients (mean (SD) age 66 (12) years; 104 men (65%); median (IQR) baseline NIHSS 14 (9–18); IV lysis, n=97 (60.6%)) were treated for a cervical carotid artery occlusion or stenosis using a CASPER stent (MicroVention), and received mechanical thrombectomy for an intracranial occlusion between April 2014 and November 2018. During the procedure or within 72 hours, formation of thrombus and complete occlusion of the CASPER stent was observed in 33/160 (20.8%) and in 12/160 patients (7.5%), respectively. In 25/33 (75.8%) and in 9/12 patients (75%), respectively, this occurred during the procedure. No statistically significant difference was observed between patients with and without thrombus formation with regard to pre-existing long term medication with anticoagulants or intraprocedural administration of heparin, acetylsalicylic acid (ASA), or heparin and ASA. Favorable early neurological outcome was similar in patients with (n=15; 45.5%) and without (n=63; 49.6%) thrombus formation at the CASPER stent.ConclusionAcute thrombosis or occlusion of CASPER stents in thrombectomy patients receiving emergent extracranial internal carotid artery stenting for tandem occlusions were observed more often during the procedure than within 72 hours of follow-up, were less frequent then previously reported, and showed no impact on early neurological outcome.

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Section: Discussionmentioning

confidence: 82%

Acute thromboses and occlusions of dual layer carotid stents in endovascular treatment of tandem occlusions

Pfaff

Maurer

Müller-Thies-Broussalis

et al. 2019

J NeuroIntervent Surg

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“…Aside from the optimal approach considering treatment of the proximal carotid lesions, questions about periprocedural interventional antithrombotic treatment [7,[18][19][20] as well as the optimal choice of stents have been raised. Although carotid stents have been available for some years, novel dual layer closed cell stents like the CASPER™ stent (Terumo Microvention, Aliso Viejo, CA, USA) or the CGuard stent (InspireMD, Boston, MA, USA) promise better plaque coverage due to smaller cell size compared to the older generation stents, thus minimizing the risk of thromboembolic events during placement and show promising results in elective patients [21][22][23][24]. The issue of early stent occlusion within 24-72 h after stenting of the ICA in patients with tandem pathologies has only been addressed in a small number of studies with numbers ranging between 0% and 19% [8,9,15,16,[25][26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Complication Rates Using CASPER Dual-Layer Stents for Carotid Artery Stenting in Acute Stroke

2019

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Background and PurposeThe number of acute and early stent occlusions after emergency stenting of the internal carotid artery (ICA) in patients with tandem lesions is unclear and only mentioned in a small number of publications, ranging from 0-20%. A recent article by Yilmaz et al. reported a high rate of acute in-stent occlusions of 45% within 72 h after deployment of CASPER dual layer stents. Methods All patients with acute ischemic stroke treated with a CASPER stent between August 2014 and April 2018 were retrospectively evaluated for occlusion rates, periinterventional medication and early complications. A total of 66 patients, 45 with tandem pathologies and 21 with proximal ICA stenosis only were enrolled. Results Thrombotic complications occurred in 16 out of 66 patients (24%) and hemorrhagic complications in 8/66 (12%) and 15 of the 16 thrombotic complications and 7/8 symptomatic intracranial hemorrhages (sICH) occurred in patients with tandem lesions and accessory intracranial thrombectomy. Of the patients with sICH five were treated in a prolonged or unknown time window. In patients with intraprocedural thrombotic complications ultrasound imaging showed patent stents in 13 of the 14 patients Conclusions The CASPER stent system showed a high technical success rate in patients with acute stroke. The number of patients with sICH was not higher than the numbers reported in the published literature despite the early use of Gp IIb/IIIA inhibitors, whereas the number of thrombotic complications was smaller than that reported in recent studies. The majority of sICH occurred in patients treated because of tandem lesions in an unknown or prolonged time window. Abbreviations +ic Carotid stent and intracranial thrombectomy -ic Carotid stent only ASA Acetylsalicylic acid CCDS Color coded duplex sonography CTA Computed tomograph angiography Gp IIb/IIIa Glycoprotein IIb/IIIa F. Runck

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“…Although the single-layer, open-cell design makes the delivery system more rigid than the CP, it provides a smaller contact surface, which may reduce thrombogenicity and the risk of venous occlusion. The CP (Microvention, Terumo, Tustin, CA, USA) is a self-expanding, braided, nitinol stent with a dual-layer micromesh design, originally developed to treat patients with carotid artery stenosis [23]. Its inner layer has small cells measuring 375-500 µm, which are meant to reduce the risk of plaque prolapse and embolic release [24].…”

Section: Stent Systemsmentioning

confidence: 99%

Casper Versus Precise Stent for the Treatment of Patients with Idiopathic Intracranial Hypertension

et al. 2021

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Purpose We hypothesized that due to its specific characteristics, the CasperTM RX carotid stent (CP) might be particularly suitable for venous sinus stenting (VSS) in patients with idiopathic intracranial hypertension (IIH). To test this theory, we compared it to the commonly used Precise Pro RXTM stent (PP). Methods A total of 15 patients with IIH (median age 28.7 years) were reviewed retrospectively. Technical aspects as well as periinterventional and postinterventional complication rates were examined in patients treated with CP (n = 10) and the PP (n = 5). Improvements in cerebrospinal fluid opening pressure (CSF OP), transstenotic pressure gradient (TSPG) and clinical symptoms were also assessed. Results are shown as percentages and respective P-values. Results Stent delivery was easier and more successful with the CP than the PP (difficult/failed stent delivery 0.0% versus 57.1%). No severe peri- or postinterventional complications or instances of in-stent thrombosis and/or stenosis were observed during follow-up. Improvement of CSF OP and TSPG immediately after VSS as well as at 6‑month follow-up were comparable between the CP and PP groups. Both groups showed substantial and similar decreases in intensity and frequency of headache. Almost all patients with other IIH-related symptoms showed either improvement or complete resolution of the symptoms after VSS. All patients who were available for interview (n = 12/15) reported a substantial improvement in quality of life. Conclusion A VSS using the CP seems to be safe and effective. The CP may reduce the risk of difficult or failed stent delivery in patients with challenging intracranial venous anatomy.

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The Casper Stent System for carotid artery stenosis

Cited by 25 publications

References 27 publications

Acute thromboses and occlusions of dual layer carotid stents in endovascular treatment of tandem occlusions

Acute thromboses and occlusions of dual layer carotid stents in endovascular treatment of tandem occlusions

Complication Rates Using CASPER Dual-Layer Stents for Carotid Artery Stenting in Acute Stroke

Casper Versus Precise Stent for the Treatment of Patients with Idiopathic Intracranial Hypertension

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