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Objective: The aim of this trial was to compare the efficacy of closed-cell stents with Casper stents during carotid angioplasty stenting (CAS)., Methods: This was a randomized superiority trial in which 88 patients were enrolled. The primary end points were the incidence, number, and size of new ischemic brain lesions after CAS under distal embolic protection devices (EPD). The secondary end points included stroke, transient ischemic attack (TIA) and myocardial infarction (MI). Ischemic brain lesions were assessed by a diffusion-weighted magnetic resonance image (DW-MRI). Neurological outcomes were evaluated by means of the National Institutes of Health scale score (NIHSS) and the modified Rankin scale (mRS)., Results: Compared with closed-cell stents (n = 47), Casper stents (n = 41), resulted in no significant reduction in the incidence (44.7% versus 39%, P = 0.592), number (1.3 ± 1.8 versus 0.9 ± 1.5, p = 0.444), and size (3.9 ± 5.8 mm versus 2.8 ± 4.1 mm, p = 0.353) of new ischemic brain lesions. The global rate of stroke/TIA/MI was (2/88, 2.3%). Two TIA occurred during the hospitalization period, one in each group (1/41, 2.4% vs 1/47, 2.1%). One patient of the Casper group had an asymptomatic in-stent thrombosis. One patient of the control group had a MI (1/47, 2.1%) after discharge., Conclusion: The Casper stents did not show superiority in the rate of incidence, number and size of new silent ischemic brain lesions detect by DW-MRI when compared to close cell stents during CAS under distal EPD., (© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Early carotid revascularization (≤ 14 days) is recommended for symptomatic carotid stenosis. Carotid artery stenting (CAS) has become an alternative to carotid endarterectomy (CEA); however, safety data on early CAS is controversial. The study aims to compare early versus late CAS, when CAS is performed as a first intention revascularization strategy., Methods: A retrospective analysis of all symptomatic patients admitted to our stroke unit who underwent CAS was conducted. Patients were divided between two groups: patients who had undergone CAS within 14 days after symptoms and those who had undergone CAS later. Primary endpoints were ipsilateral ischemic stroke or ipsilateral parenchymal hemorrhage (iPH) at 30 days. The secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE) at the 30-day and at the 12-month follow-up., Results: One hundred twenty-seven consecutive patients were evaluated. Primary endpoints obtained in the early and late CAS groups were, respectively, ipsilateral stroke (2.0% vs. 2.6%, P = 1.00) and iPH (2.0% vs. 0.0%, P = 0.40). The rates of MACCE between the early and the late CAS groups were, respectively, (7.8% vs. 2.6%, P = 0.21) at the 30-day follow-up, and (12.2% vs. 10.5%, P = 0.77) at the 12-month follow-up., Conclusions: In this study, CAS seems to be safe when used as first intention revascularization treatment within 2 weeks of symptoms, if infarcted area is less than one third of the middle cerebral artery territory. Our results need to be confirmed by larger studies., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objective: To report our experience in carotid artery stenting (CAS) with GORE flow reversal system, focusing the assessment of its efficacy, security and practice procedure evolution., Methods: Twelve patients treated for atherosclerotic carotid stenosis were prospectively evaluated. All patients were symptomatic. Carotid symptoms were embolic stroke in eight, watershed stroke in two and transient ischemic attack (TIA) in two patients. All patients underwent carotid ultrasound, brain magnetic resonance image and magnetic resonance angiography before CAS procedure. The procedure time and the flow reversal time were registered. Neurological outcome was evaluated before treatment, during the first 48 hours post-treatment and after 3 months., Results: CAS was successful in all cases. Mean procedure time was 33.8 minutes. Mean flow reversal time was 7.3 minutes. Temporary bradycardia occurred with six patients without associated hemodynamic instability. NIHSS patients' scores ranged from 0 to 5 (average 1.1) on admission and remained unchanged during 48 hours after treatment. mRS patients' scores ranged from 0 to 3 (average 1.6) on admission and remained unchanged during the follow-up of 3 months. There were no complications concerning groin puncture, or general anesthesia, or myocardial infarct or death., Conclusion: In our present selected subjects, the CAS procedure using the GORE flow reversal system appeared to be safe and effective, with improved technical performance of the procedure. This was observed in particular with the flow-reversal times achieved. Thus, studies comparing the GORE system and other protection devices are suggested to ascertain all of the benefits of flow reversal during CAS., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)