O-105 - CAROTID ARTERY STENTING WITH DOUBLE LAYER STENT: A SYSTEMATIC REVIEW AND META-ANALYSIS

TOPIC:
New vascular techniques and devices
AUTHORS:
Pini R. (Vascular Surgery, Policlinico S. Orsola Malpighi, IRCCS ~ Bologna ~ Italy) , Faggioli G. (Vascular Surgery, Policlinico S. Orsola Malpighi, IRCCS ~ Bologna ~ Italy) , Paraskevas K.I. (Department of Vascular Surgery, Central Clinic of Athens ~ Athens ~ Greece) , Campana F. (Vascular Surgery, Policlinico S. Orsola Malpighi, IRCCS ~ Bologna ~ Italy) , Sufali G. (Vascular Surgery, Policlinico S. Orsola Malpighi, IRCCS ~ Bologna ~ Italy) , Rocchi C. (Vascular Surgery, Policlinico S. Orsola Malpighi, IRCCS ~ Bologna ~ Italy) , Palermo S. (Vascular Surgery, Policlinico S. Orsola Malpighi, IRCCS ~ Bologna ~ Italy) , Vacirca A. (Vascular Surgery, Policlinico S. Orsola Malpighi, IRCCS ~ Bologna ~ Italy) , Gallitto E. (Vascular Surgery, Policlinico S. Orsola Malpighi, IRCCS ~ Bologna ~ Italy) , Gargiulo M. (Vascular Surgery, Policlinico S. Orsola Malpighi, IRCCS ~ Bologna ~ Italy)
Introduction:
Carotid artery stenting (CAS) in the treatment of significant stenosis is a cause of stroke due to both plaque prolapse and cerebral embolization. New types of stents with a double layer structure have been designed to minimize plaque prolapse and embolization; these double layer stents (DLS) should be able to reduce the stroke risk; however, definite data on their performance are scarce in the literature.
Methods:
A systematic search was performed through PubMed, Scopus, and Cochrane Library, according to PRISMA guidelines; all studies on CAS with DLS (Roadsaver/Casper - Terumo, Tokyo, Japan or CGuard - InspireMD, Boston, Massachusetts) up to January 1st, 2022, with a cohort of at least 20 patients were considered eligible. The present meta-analysis was approved and registered on PROSPERO register (CRD42022297512). Patients with tandem lesions or complete carotid occlusion were excluded from the study. The 30-day stroke rate after CAS was analyzed evaluating the preoperative symptomatic status and DLS occlusion. The estimated pooled rate of events was calculated by random effect model and moderators were evaluated.
Results:
A total of 14 studies were included in the meta-analysis for a total of 1955 patients. The estimated overall (95% confidence interval [CI]) stroke rate was 1.4% (0.9%-2.2%, I2=0%), which was not influenced by the type of DLS used: CGuard 0.8% (0.4%-1.8%, I2=0%) vs Roadsaver/Casper 1.5% (0.7%-3.2%, I2=0%), p=0.30. The 30-day estimated stroke rate was 1.5% (0.8%-2.9%, I2=0%) in asymptomatic and 1.9% (1.0%-3.6%, I2=0%) in symptomatic patients, with no influence by moderators. The 30-day DLS occlusion rate was 0.8% (0.4%-1.8%, I2=0%). The publication bias assessment identified asymmetry in the asymptomatic populations.
Conclusion:
The overall 30-day stroke rate in CAS with DLS is low (1.4%), with similar results in symptomatic (1.9%) and asymptomatic (1.5%) patients. Acute occlusion of DLS is rare (0.8%). Further studies are necessary to reduce the publication bias for asymptomatic patients.