Casper Stent Research Articles

Clinical results of 30 consecutive patients of carotid artery stenosis treated with CASPER stent placement: 1-year follow-up and in-stent findings on intravascular ultrasound examination immediately and 6 months after treatment

BackgroundThe CASPER stent is expected to reduce periprocedural ischemic complications, but there is concern about restenosis in the early period. One-year follow-up results of CASPER stenting and findings on intravascular...

Carotid artery stenting with double-layer micromesh stent (CASPER stent)—the time-related changes in residual ulceration outside the stent

Carotid artery stenting with double-layer micromesh stent (CASPER stent)—the time-related changes in residual ulceration outside the stent

The case of treatment for carotid web - Double-layer micromesh stent implantation in our hospital.

A carotid web is a shelf-like structure on the posterior wall of the origin of the internal carotid artery, and it is believed to cause cerebral infarction due to thrombus formed by turbulent flow with stagnation of blood flow. Recently, it has been suggested that recurrent cerebral infarction cannot be prevented in patients with a symptomatic carotid web by conventional medical management alone. However, there is still no consensus on the treatment of carotid webs. Carotid artery stenting (CAS) with the CASPER stent (Microvention, Terumo, Tustin, CA, USA) was performed in six consecutive patients with symptomatic carotid webs, and the results are reported along with a review of the literature. Six consecutive patients with a diagnosis of internal carotid artery stenosis due to a carotid web on magnetic resonance imaging and digital subtraction angiography (DSA) were included in this study. All patients underwent dual antiplatelet therapy approximately 10 days before surgery and after 6 months, and then, a CASPER stent was implanted under general anesthesia. All patients were evaluated postoperatively by DSA 6 months after treatment. In all patients, no in-stent stenosis was seen 6 months after the operation, and no symptomatic cerebral infarction occurred within 1 year after the procedure. CASPER stent implantation may be effective for treating carotid webs.

Strategy of cerebral endovascular treatment for cervical internal carotid artery stenosis with a persistent primitive hypoglossal artery.

Persistent primitive hypoglossal artery (PPHA) is a rare residual arterial anastomosis. We placed a CASPER stent using Spider FX as an embolic protection device (EPD) in a patient with internal carotid artery (ICA) stenosis and PPHA. There are no reports of carotid artery stenting (CAS) using a CASPER stent for ICA stenosis with PPHA. We report the EPD strategy used in this case and the usefulness and precautions of CASPER stent insertion for cervical ICA stenosis in association with PPHA. A 9Fr sheath was placed in the right femoral artery and a 9Fr Branchor balloon guide catheter was guided to the common carotid artery. A Spider FX was placed proximal to the bifurcation of the ICA and the PPHA. A 10 mm × 20 mm CASPER stent was deployed at the site of the stricture with no postoperative ischemic complications. There was no intra-stent occlusion, stenosis, or plaque protrusion immediately after surgery, and no postoperative ischemic complications were observed. CASPER stent deployment with the Spider FX in the ICA and PPHA bifurcation can be considered to be an effective treatment method for ICA stenosis associated with PPHA. However, care should be taken in selecting the appropriate EPDs and stents depending on the location of the stenosis and bifurcation of the PPHA.

Endovascular Stent Thrombectomy in Patients With Acute Lower Limb Arterial Thrombosis on the Background of COVID-19

AIM Analysis of the outcomes of endovascular stent thrombectomy in patients with acute arterial thrombosis of the lower extremities on the background of COVID-19.MATERIAL AND METHODS This retrospective study for the period from January 1, 2020 to March 1, 2022 included 34 patients with acute lower limb ischemia who were diagnosed with the novel coronavirus infection SARS-COV-2. Endovascular stent thrombectomy was performed according to the standard technique using a Destination 8F guiding sheath (Terumo), an Advantage 0.014`` guidewire (Terumo), and a Casper stent (Microvention, Terumo) as a stent retriever. In case of fragmentation of thrombotic masses in the guide sheath, manual aspiration of thrombi was performed using a standard 50,0 ml syringe. Self-expanding nitinol stents were implanted in 11 clinical cases.RESULTS Intraoperative bleeding from the puncture site of the artery developed in 14.7% of cases, which required additional manipulation to achieve hemostasis. Every tenth (11.8%) patient developed myocardial infarction, in 2.9% of cases — ischemic stroke. In the hospital postoperative period during the first hours after surgery, 26.5% of patients developed rethrombosis which required re-intervention. In 8.8% of cases, retrombectomy was unsuccessful, and limb amputation was performed. A fatal outcome occurred in 67.6% of cases, which was due to an increase in multiple organ failure and the development of sepsis.CONCLUSION Endovascular stent thrombectomy is characterized by a low risk of rethrombosis and amputation in the context of COVID-19.

Dual-layer carotid stenting for symptomatic carotid web: Results from the Caroweb study

Background & purposeCarotid Web (CaW) is a growingly recognized cause of ischemic stroke, associated with a high recurrence risk. Several therapeutic strategies have been proposed as a tertiary prevention including carotid stenting, endarterectomy and antithrombotic medications. Among these, carotid stenting with dual-layer stent may be promising to adequately cover the focal arterial dysplasia. Our aim was to investigate the safety and efficacy of the Casper stent in the treatment of symptomatic CaW. MethodsWe conducted a retrospective analysis of consecutive patients presenting with a symptomatic CaW and included in the ongoing prospective observational multicenter CAROWEB registry. The study period was January 2015 to December 2021. Inclusion criteria were CaW treated with dual-layer Casper stent. Patients treated with other types of carotid stent, endarterectomy or antithrombotic medication were excluded. Clinical and radiological initial data and outcomes were recorded. Resultstwenty-seven patients (with 28 caw) were included. median age was 52 (iqr: 46–68). median delay between index cerebrovascular event and cervical stenting was 9 days (IQR: 6–101). In all cases, the cervical carotid stenting was successfully performed. No major perioperative complication was recorded. No recurrent stroke or transient ischemic attack was observed during a median follow-up time of 272 days (IQR: 114–635). Long-term imaging follow-up was available in 25/28 (89.3%) stented CaW with a median imaging follow-up of 183 days (IQR: 107–676; range: 90–1542). No in-stent occlusion or stenosis was detected. ConclusionIn this study, carotid stenting with dual-layer Casper stent in the treatment of symptomatic CaW was effective regarding stroke recurrence prevention and safe, without procedural nor delayed detected adverse event. However, the optimal therapeutic approach of symptomatic CaW still needs to be explored through randomized trials.

Clinical trial of carotid artery stenting using dual-layer CASPER stent for carotid endarterectomy in patients at high and normal risk in the Japanese population

BackgroundThe dual-layer nitinol CASPER stent was designed to prevent plaque prolapse into its strut and periprocedural stroke.ObjectiveTo conduct a clinical trial for government approval of the device in patients at...

Endovascular flow-diversion of visceral and renal artery aneurysms using dual-layer braided nitinol carotid stents

BackgroundVisceral and renal artery aneurysms (VRAAs) are uncommon but are associated with a high mortality rate in the event of rupture. Endovascular treatment is now first line in many centres, but preservation of arterial flow may be difficult in unfavourable anatomy including wide necked aneurysms, parent artery tortuosity and proximity to arterial bifurcations. Endovascular stenting, and in particular flow-diversion, is used in neurovascular intervention to treat intracranial aneurysms but is less often utilised in the treatment of VRAAs. The CASPER stent is a low profile dual-layer braided nitinol stent designed for carotid stenting with embolic protection and flow-diversion properties. We report the novel use of the CASPER stent for the treatment of VRAAs. We present a case series describing the treatment of six patients with VRAAs using the CASPER stent.ResultsSix patients with unruptured VRAAs were treated electively. There were three splenic artery aneurysms and three renalartery aneurysms. Aneurysms were treated with the CASPER stent, with or without loose aneurysm coil packing or liquid embolic depending on size and morphology. All stents were successfully deployed with no immediate or periprocedural complications. Four aneurysms completely occluded after serial imaging follow up with one case requiring repeat CASPER stenting for complete occlusion. In one patient a single aneurysm remained patent at last follow up, A single case was complicated by delated splenic infarction and surgical splenectomy.ConclusionPreliminary experience with the CASPER stent suggests it is technically feasible and effective for use in the treatment of VRAAs.

Carotid Calcium Volume and Stenosis after Stent Implantation

IntroductionInternal carotid artery (ICA) stenosis could be treated with stent placement. It was hypothesized that calcium amount could be predictive of vessel stenosis after stent placement. We utilised computed tomography (CT) angiography to quantify volume of calcium material in bulbar ICA. Materials and methods28 patients with 31 treated ICA stenosis were collected and analysed using CT angiography-based calcium volume measurement. The Casper stent system (CSS) was used exclusively. Prospective data on emergent carotid stenosis were collected using serial ultrasound controls over a 12-month period. ResultsMedian age was 76 years (interquartile range (IQR) 67.5-77.8) and the majority were men (71.4%). Plaque median calcium volume was 0.142 cm3 (IQR 0.030 – 0.227) and median average Hounsfield Units (HU) were 561.0 (414.5-675.0). We detected positive linear relationship between average HU and ICA calcium volume. Furthermore, weak positive correlation was observed between calcium volume and residual stenosis as seen on post-interventional angiography, (correlation coefficient R = 0.38, p=0.035). Stronger positive correlation emerged between plaques’ average HU and residual stenosis (R = 0.42, p=0.018). Angiographic stenosis showed univariate association with late stenosis as detected 12 months after CAS. ConclusionCalcium burden could be associated with residual stenosis after CSS placement. Larger studies are needed to confirm our preliminary data.

Complication Rates Using CASPER Dual-Layer Stents for Carotid Artery Stenting in Acute Stroke : A3-Year Single Center Experience.

The number of acute and early stent occlusions after emergency stenting of the internal carotid artery (ICA) in patients with tandem lesions is unclear and only mentioned in asmall number of publications, ranging from 0-20%. Arecent article by Yilmaz etal. reported ahigh rate of acute in-stent occlusions of 45% within 72 h after deployment of CASPER dual layer stents. All patients with acute ischemic stroke treated with a CASPER stent between August 2014 and April 2018 were retrospectively evaluated for occlusion rates, periinterventional medication and early complications. Atotal of 66patients, 45with tandem pathologies and 21with proximal ICA stenosis only were enrolled. Thrombotic complications occurred in 16 out of 66 patients (24%) and hemorrhagic complications in 8/66 (12%) and 15 of the 16thrombotic complications and 7/8symptomatic intracranial hemorrhages (sICH) occurred in patients with tandem lesions and accessory intracranial thrombectomy. Of the patients with sICH five were treated in aprolonged or unknown time window. In patients with intraprocedural thrombotic complications ultrasound imaging showed patent stents in 13 of the 14patients CONCLUSIONS: The CASPER stent system showed ahigh technical success rate in patients with acute stroke. The number of patients with sICH was not higher than the numbers reported in the published literature despite the early use of Gp IIb/IIIA inhibitors, whereas the number of thrombotic complications was smaller than that reported in recent studies. The majority of sICH occurred in patients treated because of tandem lesions in an unknown or prolonged time window.

Acute thromboses and occlusions of dual layer carotid stents in endovascular treatment of tandem occlusions

PurposeTo evaluate the occurrence and risk factors of acute in-stent thrombosis or stent occlusion in patients with tandem occlusions receiving intracranial mechanical thrombectomy and emergent extracranial internal carotid artery stenting...

Predictors of acute cerebral embolic lesions during carotid artery stenting

The authors carried out a prospective study aimed at revealing predictors of acute embolic lesions of cerebral vessels during angioplasty with stenting of the internal carotid artery. The study enrolled a total of 54 patients who between May 2015 and December 2018 underwent carotid angioplasty with stenting performed at the Department of Vascular and Endovascular Surgery of the Research Centre of Neurology. The procedure of internal carotid artery stenting may be accompanied by intraoperative acute embolic lesions. In order to reveal intraoperative acute embolic lesions of cerebral vessels all patients before and 24 hours after the intervention were subjected to diffusion-weighted magnetic resonance imaging. Thirty-six patients received classical carotid stents (Xact and Acculink) and 18 patients received Casper stents. The patients of both groups were comparable by 24 characteristics studied, including the incidence of intraoperative acute cerebral embolic lesions (18/36 for the classical stents and 10/18 for the Casper stent), which made it possible to unite them into one group in order to increase the power of the study. All acute embolic lesions detected by the diffusion-weighted magnetic resonance imaging (prior to stenting and 24 hours thereafter) were clinically, asymptomatic with no perioperative stroke observed. In order to reveal predictors of intraoperative acute embolic lesions of cerebral vessels we analysed 22 characteristics of the patients, with the obtained findings demonstrating the following signs: a low-intensity (below 20 dB) ultrasonographic signal reflected from fragments of an atherosclerotic plaque during ultrasound examination prior to stenting (p=0.001) - a sign strongly associated with acute embolic lesions (sensitivity - 75%, specificity - 92%); symptomatic stenosis according to the anamnestic data (p=0.02) - a sign significantly associated with acute embolic lesions; female gender (p=0.06) - a sign moderately associated with acute embolic lesions; a history previously endured (according to the anamnestic data) operations on coronary and/or carotid arteries (p=0.09) - a sign weakly associated with acute embolic lesions. Based on the obtained findings we proposed a prognostic scale to assess the risk of acute embolic lesions of cerebral vessels during internal carotid artery stenting. Knowing the factors associated with intraoperative acute embolic lesions will allow the endovascular surgeon to single out the patients at increased risk of acute embolic lesions.

Reduction of cerebral DWI lesion burden after carotid artery stenting using the CASPER stent system

IntroductionDespite various measures to protect against distal embolization during carotid artery stenting (CAS), periprocedural ischemic lesions are still encountered.ObjectiveTo evaluate the periprocedural cerebral diffusion weighted imaging (DWI) lesion burden after...

The Casper Stent System for carotid artery stenosis

PurposeTo report the results of a retrospective analysis of prospectively collected data evaluating the safety and efficacy of a double layer stent engineered for carotid artery occlusive disease.MethodsBetween January 2014...

Проблема мікроемболії при каротидному стентуванні та її вирішення

Objective – to reduce of frequency of microembolism in carotid stenting with optimizing the choice of anti-embolic protection and using double-layer stents. Materials and methods. In the endovascular center of the Dnipropetrovsk Regional Hospital named after I.I. Mechnikov 41 patients (24 men and 17 women, aged from 56 to 81 years, average age – 66.9 year) underwent carotid stenting with the use of Casper double-layer carotid stents (Micro- Vention) and a differentiated approach to the choice of anti-embolic protection for the last 9 months. 47 operations of carotid stenting were performed. Before carotid stenting and in the early postoperative period (1-2 days), patients underwent MRI of the brain with a DWI protocol to determine the appearance of new embolic ischemic lesions in the postoperative period. Distal anti-embolic devices were used in all cases where the risk of their use was not regarded as increased (n = 43). The proximal anti-embolic device Mo.MaUltra (Medtronic) was used in three cases with extended stenosis, «complicated» subtotal stenosis. The method of combined usage of the proximal anti-embolic device Mo.MaUltra and the distal anti-embolic device was used in a case with complicated subtotal extended carotid stenosis and temporary carotid artery occlusion intolerance. In all observations plaques in the initial segment of the internal carotid arteries had signs that increased the risk of microembolism in the postoperative period with the usage of not double-layered design carotid stents. Therefore, we used Casper double-layer stents in these cases. Results. Elimination of the carotid stenosis was achieved in 100 % of cases. After the Casper stent implantation, if there were ulcerations, angiographically, there was no contrasting under the stent in ulcerations, or prolonged stagnation in them. There were also no angiographic signs of plaque prolapse through the structure of the stent. MRI of the brain in the DWI-regime did not show any new ischemic lesions in a control study after carotid stenting (1-2 days). There was anneurological improvement in 85.4 % of cases (35 patients). The condition of other patients remained stable, without deterioration in the neurological status. The clinic of ischemic stroke did not develop in any patient for the period from 30 days to 9 months after carotid stenting. Moderate hyperperfusion syndrome developed in the postoperative period in 2 cases (4.9 %) with complete regression of symptoms in the subsequent period. Postoperative mortality was 0 %. There were no local complications at the artery puncture site. Conclusions. Analysis of the results of treatment of patients with carotid stenoses with the usage of double-layer stents and a differentiated choice of the method of anti-embolic protection showed that this approach can lead the carotid stenting technique to a new level of efficiency and safety.

Potential of New-Generation Double-Layer Micromesh Stent for Carotid Artery Stenting in Patients with Unstable Plaque: A Preliminary Result Using OFDI Analysis.

One disadvantage of carotid artery stenting (CAS) is a high incidence of distal embolism (DE) during or after the procedure. Patients with unstable plaque are considered at high risk for DE and plaque protrusion (PP) after stent placement, which can cause postprocedural ischemic complications. This study was conducted to compare the rate and size of PP between the CASPER stent, a new-generation double-layer micromesh stent, and conventional stents as assessed by optical frequency domain imaging (OFDI), and also to evaluate the efficacy of CAS with the CASPER stent in cases with unstable plaque. The study group comprised 46 consecutive patients with unstable plaque, identified on magnetic resonance imaging, undergoing CAS with OFDI image acquisition. Cross-sectional OFDI images within the stented segments were evaluated at 0.125-mm intervals, and the rate and size of PP were compared between the CASPER stent and conventional stents. The CASPER stent was used in 9 patients. No procedural complications occurred. On OFDI analysis, the presence of PP was apparently lower in CASPER stent group compared with the conventional stent group (44% vs. 88%; P= 0.022). In addition, mean PP area was significantly smaller in the CASPER stent group (mean PP area, 0.013 ± 0.034 mm2 vs. 0.057 ± 0.09 mm2; P= 0.006). On OFDI evaluation after CAS, the degree of PP was significantly smaller in the CASPER stent group compared with the conventional stent group. This result provides new insight into the use of CAS to treat carotid artery stenosis with unstable plaque.

CREST-2: Identifying the Best Method of Stroke Prevention for Carotid Artery Stenosis: National Institute of Neurological Disorders and Stroke Organizational Update.

One of the great achievements of modern medicine is the successful prevention of stroke and other cardiovascular diseases. Although the incidence of stroke has substantially declined over the last 30 years, ≈200 000 preventable stroke deaths still occur annually in the United States. According to a recent study based on the Greater Cincinnati/Northern Kentucky Stroke Study, annually ≈41 000 strokes in the United States are attributed to extracranial internal carotid artery stenosis. Early revascularization for symptomatic carotid stenosis—that is, in patients with recent ipsilateral stroke or TIA—is well established as effective at preventing ipsilateral stroke. Carotid stenosis in the absence of symptoms is extremely common, but the best treatment is unclear. While 2 randomized trials showed a benefit of carotid endarterectomy (CEA) over antiplatelet therapy with aspirin, the number needed to treat approaches 200. Does aggressive risk factor control change that balance? Population screening for carotid stenosis followed by revascularization is considered to cause net harm. Are complication rates from endarterectomy and stenting now low enough to justify expanding their indications in asymptomatic patients? The National Institute of Neurological Disorders and Stroke (NINDS)–funded CREST-2 trial (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial) is an ambitious attempt to further refine the treatment of asymptomatic carotid stenosis. As one of the largest randomized stroke prevention trials, the first CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial) was designed to compare the safety and efficacy of 2 stroke prevention procedures for carotid artery narrowing—CEA and carotid artery stenting (CAS)—in symptomatic and asymptomatic individuals. Starting in December 2000, this NINDS-funded trial enrolled >2500 patients at 117 sites in the United States and Canada. Because of slow enrollment, the trial took 9 years to complete. In 2010, the results of CREST indicated that the 2 revascularization procedures were equivalent for …

The Dual Layer Casper Micromesh Stent: Taking Advantage of Flow-Diverting Capabilities for the Treatment of Extracranial Aneurysms and Pseudoaneurysms.

(Microvention, Tustin, CA) is a low-profile closed cell stent with an increased mesh density and reduced pore size compared to commonly utilized stents in carotid artery procedures. We describe our preliminary experience from flow diversion in two iatrogenic ECAP with the Casper stent in a retrospective observational analysis of patients with extracranial aneurysms treated endovascularly with the Casper stent. Patients were followed for up to 6 months (clinical exam and imaging). According to the institutional review board, the current analysis did not require approval. All patients or their legal representatives gave informed consent.