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One swallow does not a summer make but many swallows do : accumulating clinical evidence for nearly-eliminated peri-procedural and 30-day complications with mesh - covered stents transforms the carotid revascularisation field
carotid artery stenting
mesh
stroke
endarterectomy
neuroprotection
Atherosclerotic carotid artery stenosis (CS) continues to be a common cause of acute ischaemic stroke. Optimised medical therapy (OMT), the first-line treatment modality in CS, may reduce or delay – but it does not abolish – CS-related strokes. As per current AHA/ASA and ESC/ESVS/ESO guidelines, carotid artery stenting (CAS) is a less-invasive alternative to carotid endarterectomy (CEA) for CS revascularisation in primary and secondary stroke prevention. Ten-year follow-up from the CREST trial in patients with symptomatic and asymptomatic CS confirmed equipoise of CAS and CEA in the primary endpoint. Nevertheless CAS – using a widely open-cell, first-generation stent and first-generation (distal/filter) neuroprotection – has been criticised for its relative excess of (mostly minor) strokes by 30 days, a significant proportion of which were post-procedural. Atherosclerotic plaque protrusion through conventional carotid stent struts, confirmed on intravascular imaging, has been implicated as a leading mechanism of the relative excess of strokes with CAS vs. CEA, including delayed strokes with CAS. Different designs of mesh-covered carotid stents have been developed to prevent plaque prolapse. Several multi-centre/multi-specialty clinical studies with CGurad MicroNet-Covered Embolic Prevention Stent System (EPS) and RoadSaver/Casper were recently published and included routine DW-MRI cerebral imaging peri-procedurally and at 30 days (CGuard EPS). Data from more than 550 patients in mesh-covered carotid stent clinical studies to-date show an overall 30-day complication rate of ~1% with near-elimination of post-procedural events. While more (and long-term) evidence is still anticipated, these results – taken together with optimised intra-procedural neuroprotection in CAS (increased use of proximal systems including trans-carotid dynamic flow reversal) and the positive 12-month mesh-covered stent data reports in 2017 – are transforming the carotid revascularisation field today. Establishing effective algorithms to identify the asymptomatic subjects at stroke risk despite OMT, and large-scale studies with mesh-covered stents including long-term clinical and duplex ultrasound outcomes, are the next major goals.
cris.lastimport.wos | 2024-04-09T22:06:52Z | |
dc.abstract.en | Atherosclerotic carotid artery stenosis (CS) continues to be a common cause of acute ischaemic stroke. Optimised medical therapy (OMT), the first-line treatment modality in CS, may reduce or delay – but it does not abolish – CS-related strokes. As per current AHA/ASA and ESC/ESVS/ESO guidelines, carotid artery stenting (CAS) is a less-invasive alternative to carotid endarterectomy (CEA) for CS revascularisation in primary and secondary stroke prevention. Ten-year follow-up from the CREST trial in patients with symptomatic and asymptomatic CS confirmed equipoise of CAS and CEA in the primary endpoint. Nevertheless CAS – using a widely open-cell, first-generation stent and first-generation (distal/filter) neuroprotection – has been criticised for its relative excess of (mostly minor) strokes by 30 days, a significant proportion of which were post-procedural. Atherosclerotic plaque protrusion through conventional carotid stent struts, confirmed on intravascular imaging, has been implicated as a leading mechanism of the relative excess of strokes with CAS vs. CEA, including delayed strokes with CAS. Different designs of mesh-covered carotid stents have been developed to prevent plaque prolapse. Several multi-centre/multi-specialty clinical studies with CGurad MicroNet-Covered Embolic Prevention Stent System (EPS) and RoadSaver/Casper were recently published and included routine DW-MRI cerebral imaging peri-procedurally and at 30 days (CGuard EPS). Data from more than 550 patients in mesh-covered carotid stent clinical studies to-date show an overall 30-day complication rate of ~1% with near-elimination of post-procedural events. While more (and long-term) evidence is still anticipated, these results – taken together with optimised intra-procedural neuroprotection in CAS (increased use of proximal systems including trans-carotid dynamic flow reversal) and the positive 12-month mesh-covered stent data reports in 2017 – are transforming the carotid revascularisation field today. Establishing effective algorithms to identify the asymptomatic subjects at stroke risk despite OMT, and large-scale studies with mesh-covered stents including long-term clinical and duplex ultrasound outcomes, are the next major goals. | pl |
dc.affiliation | Wydział Lekarski : Instytut Kardiologii | pl |
dc.cm.date | 2020-01-07 | |
dc.cm.id | 84887 | |
dc.contributor.author | Musiałek, Piotr - 173944 | pl |
dc.contributor.author | Hopkins, L. Nelson | pl |
dc.contributor.author | Siddiqui, Adnan H. | pl |
dc.date.accessioned | 2020-01-17T09:17:51Z | |
dc.date.available | 2020-01-17T09:17:51Z | |
dc.date.issued | 2017 | pl |
dc.date.openaccess | 0 | |
dc.description.accesstime | w momencie opublikowania | |
dc.description.number | 2 (48) | pl |
dc.description.physical | 95-106 | pl |
dc.description.points | 15 | pl |
dc.description.version | ostateczna wersja wydawcy | |
dc.description.volume | 13 | pl |
dc.identifier.doi | 10.5114/pwki.2017.69012 | pl |
dc.identifier.eissn | 1897-4295 | pl |
dc.identifier.issn | 1734-9338 | pl |
dc.identifier.project | ROD UJ / OP | pl |
dc.identifier.uri | https://ruj.uj.edu.pl/xmlui/handle/item/141316 | |
dc.language | eng | pl |
dc.language.container | eng | pl |
dc.rights | Udzielam licencji. Uznanie autorstwa - Użycie niekomercyjne - Na tych samych warunkach 4.0 Międzynarodowa | * |
dc.rights.licence | CC-BY-NC-SA | |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-sa/4.0/legalcode.pl | * |
dc.share.type | otwarte czasopismo | |
dc.subject.en | carotid artery stenting | pl |
dc.subject.en | mesh | pl |
dc.subject.en | stroke | pl |
dc.subject.en | endarterectomy | pl |
dc.subject.en | neuroprotection | pl |
dc.subtype | ReviewArticle | pl |
dc.title | One swallow does not a summer make but many swallows do : accumulating clinical evidence for nearly-eliminated peri-procedural and 30-day complications with mesh - covered stents transforms the carotid revascularisation field | pl |
dc.title.journal | Postępy w Kardiologii Interwencyjnej | pl |
dc.type | JournalArticle | pl |
dspace.entity.type | Publication |
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