Carotid Artery Stenting Using a Double-layer Micromesh Stent

Successful Management of Intraprocedural Arterial Dissection During Carotid Artery Stenting With an Overlapping CASPER Rx Stent for Tortuous Vessel: A Case Report

Carotid artery stenosis is a significant cause of ischemic stroke, often necessitating interventions like carotid artery stenting (CAS) to restore adequate blood flow. However, complications like intraprocedural arterial dissection can arise during the procedure. This report presents a case of intraprocedural arterial dissection during CAS using a CASPER Rx stent. A 77-year-old male, previously diagnosed with asymptomatic right internal carotid artery (ICA) stenosis two years earlier, was presented to our institution with transient left upper limb paralysis. CAS with a CASPER Rx stent was planned due to the progression of symptomatic ICA stenosis. During the procedure, an arterial dissection occurred in the vessel wall just distal to the stent but was successfully managed with additional stenting. The patient experienced no postoperative neurological deficits and was discharged in stable condition. This case highlights the importance of careful resheathing to avoid unintended advancement of the stent system, particularly in cases of ICA stenosis with severe vessel tortuosity. Furthermore, the present case also emphasizes the critical need of timely intervention to prevent serious complications.

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

Introduction 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.

Methods 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.

Results 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.

Conclusion 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.