Subscribe to RSS
DOI: 10.1055/s-0042-1759799
Comparison of the Outcome and Efficacy of Single-Layer versus Dual-Layer Mesh Stent among Carotid Stenosis Patients Attending a Tertiary Care Setting—A Prospective Observational Study
Funding The project was self-funded. No external agency had funded the project.
Abstract
The effect of stent design whether single-layer or double-layer on long-term durability of carotid artery stenting (CAS) is unknown. The aim of this article was to compare the clinical outcome and efficacy of single-layer versus dual-layer mesh stent for CAS among carotid stenosis patients. A prospective observational study was conducted among 41 consecutive patients, who underwent CAS procedures between November 2019 and November 2021. Procedural data and outcomes for patients treated with the single-layer stent (n = 19patients) and double-layer stent (n = 22) were compared. Procedural efficacy and complications were considered as primary outcome variable. SPSS version 22 was used for statistical analysis. Mean age of study population in dual-layer stents group was 63.86 ± 11.08 years and it was 61.47 ± 8.26 years in single-layer stent group. There was no statistically significant difference between two groups with age, stenosis, side of stenosis, prestenting angioplasty, and poststenting angioplasty (p-value >0.05). Out of 22 participants with dual-layer stent, only one (4.5%) participant experienced five episodes of transient ischemic attack in last 1 month. Both clinical and associated complaints were more in dual-layer group compared with single layer. One (5.26%) participant in single-layer group had reclusion/restenosis at 30 days. Majority in single-(57.8%) and double-layer (63.64%) stents group showed modified Rankin Scale score of 0. Restenosis after CAS occurred less frequently in patients treated with double-layer mesh when compared with single-layer stent. However, both stents were equally effective at preventing peri procedural complications.
Ethical Approval
The study was approved by the institutional ethics committee. The participants were informed in detail about the procedures involved, and they provided written informed consent in accordance with the guidelines of the Helsinki Declaration, 2008.
Authors' Contribution
V.P.K.R. has conceptualized the study and played primary role in compiling, analysis, and interpretation of the data. All the drafts were prepared, reviewed, and final draft was approved by V.P.K.R. and N.M.M. V.P.K.R. and N.M.M. have contributed in fine tuning of the proposal, data collection, and entry. They reviewed the results and contributed to preparation and review of drafts. All the authors have read and approved final version of the manuscript. All the authors take complete responsibility for the content of the manuscript.
Publication History
Article published online:
22 December 2022
© 2022. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: current epidemiology and future directions. Circulation 2016; 133 (16) 1605-1620
- 2 Abdul-Aziz AA, Desikan P, Prabhakaran D, Schroeder LF. Tackling the burden of cardiovascular diseases in India. Circ Cardiovasc Qual Outcomes 2019; 12 (04) e005195
- 3 Kamalakannan S, Gudlavalleti ASV, Gudlavalleti VSM, Goenka S, Kuper H. Incidence & prevalence of stroke in India: a systematic review. Indian J Med Res 2017; 146 (02) 175-185
- 4 Algahtani H, Shirah B, Alghamdi AS, Subahi A, Alqahtani SA, Alshamy A. Carotid artery angioplasty and stenting for carotid stenosis: a single-center experience from Saudi Arabia. Neurointervention 2020; 15 (03) 133-139
- 5 Trystuła M, Pąchalska M. Comorbidities and health-related quality of life following revascularization for asymptomatic critical internal carotid artery stenosis treated with carotid endarterectomy or angioplasty with stenting. Med Sci Monit 2019; 25: 4734-4743
- 6 Musiałek P, Roubin GS. Commentary: double-layer carotid stents: from the clinical need, through a stent-in-stent strategy, to effective plaque isolation… the journey toward safe carotid revascularization using the endovascular route. J Endovasc Ther 2019; 26 (04) 572-577
- 7 Rizwan M, Aridi HD, Dang T, Alshwaily W, Nejim B, Malas MB. Long-term outcomes of carotid endarterectomy and carotid artery stenting when performed by a single vascular surgeon. Vasc Endovascular Surg 2019; 53 (03) 216-223
- 8 Doig D, Turner EL, Dobson J. et al; ICSS Investigators. Predictors of stroke, myocardial infarction or death within 30 days of carotid artery stenting: results from the International Carotid Stenting Study. Eur J Vasc Endovasc Surg 2016; 51 (03) 327-334
- 9 Kotsugi M, Takayama K, Myouchin K. et al. Carotid artery stenting: investigation of plaque protrusion incidence and prognosis. JACC Cardiovasc Interv 2017; 10 (08) 824-831
- 10 Yamada K, Yoshimura S, Yoshida K. et al. Carotid artery stenting using a double-layer micromesh stent. J Neuroendovascular Ther. 2020; 14 (10) 407-412
- 11 Sharples LD, Kirkwood BR. Essentials of Medical Statistics. 2nd ed.. New York, US: Blackwell Scientific Publications; 1998
- 12 Aboyans V, Ricco JB, Bartelink MLEL. et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Russ J Cardiol. 2018; 23 (08) 164-221
- 13 Corp IBM. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp;
- 14 Sýkora J, Zeleňák K, Vorčák M. et al. Comparison of restenosis risk in single-layer versus dual-layer carotid stents: a duplex ultrasound evaluation. Cardiovasc Intervent Radiol 2022; 45 (09) 1257-1266
- 15 Stabile E, de Donato G, Musialek P. et al. Use of dual-layered stents in endovascular treatment of extracranial stenosis of the internal carotid artery: results of a patient-based meta-analysis of 4 clinical studies. JACC Cardiovasc Interv 2018; 11 (23) 2405-2411
- 16 Kahlberg A, Bilman V, Ardita V. et al. Contemporary results of carotid artery stenting using low-profile dual-metal layer nitinol micromesh stents in relation to single-layer carotid stents. J Endovasc Ther 2021; 28 (05) 726-736
- 17 Lal BK, Roubin GS, Jones M. et al. Influence of multiple stents on periprocedural stroke after carotid artery stenting in the Carotid Revascularization Endarterectomy versus Stent Trial (CREST). J Vasc Surg 2019; 69 (03) 800-806
- 18 Yilmaz U, Körner H, Mühl-Benninghaus R. et al. Acute occlusions of dual-layer carotid stents after endovascular emergency treatment of tandem lesions. Stroke 2017; 48 (08) 2171-2175
- 19 Ruffino MA, Faletti R, Bergamasco L, Fonio P, Righi D. Incidence of new ischaemic brain lesions after carotid artery stenting with the micromesh roadsaver carotid artery stent: a prospective single-centre study. Cardiovasc Intervent Radiol 2016; 39 (11) 1541-1549
- 20 Hopf-Jensen S, Marques L, Preiß M, Müller-Hülsbeck S. Initial clinical experience with the micromesh Roadsaver carotid artery stent for the treatment of patients with symptomatic carotid artery disease. J Endovasc Ther 2015; 22 (02) 220-225