Meta-Analysis Evaluates Dual-Layered Stents for CAS

July 27, 2020—One-year results from a patient-based meta-analysis of the safety and efficacy of dual-layered stent (DLS) systems for carotid artery stenting (CAS) were published by Eugenio Stabile, MD, et al in Journal of American College of Cardiology (JACC): Cardiovascular Interventions (2020;13:1709-1715).

The investigators concluded that the findings suggest that DLS use for CAS is associated with a low 1-year death and stroke rate, and the specific DLS stent used could affect the restenosis rate.

For this study, the investigators performed an individual patient-level meta-analysis including studies enrolling > 100 patients treated by CAS with a DLS (either Roadsaver [RS, Terumo Europe] or CGuard [CG, InspireMD]. Patients were divided into two groups according to DLS (RS, n = 250; CG, n = 306).

The primary endpoint was the death and stroke rate; secondary endpoints were restenosis and in-stent thrombosis rates at 1 year.

The 1-year findings were summarized in JACC: Cardiovascular Interventions as follows:

• 11 (1.97%) patients died at 1 year, with seven (2.8%) patients in the RS group and four (1.31%) patients in the CG group
• 10 strokes occurred at 1 year, four (1.6%) in the RS group and six (1.96%) in the CG group
• The overall death and stroke rate was 3.77% (n = 21), with 11 (4.4%) events in the RS group and 10 (3.27%) events in the CG group
• Symptomatic status was the only predictor of death and or stroke
• Restenosis occurred in 12 (2.1%) patients with 10 (4%) in the RS group and two (0.65%) in the CG group (P = .007)
• In-stent thrombosis occurred in one (0.18%) patient in the CG group (0.32%)
• RS use was the only independent predictor of restenosis