Dual-layer Stent Research Articles

The Dual-layer CGuard Stent Is Safe and Effective in Emergent Carotid Artery Stenting and in Tandem Occlusions: aMulti-centric Study.

Dual-layer stents have fallen into disrepute after several studies reported high rates of in-stent occlusions in acute stroke treatments. The CGuard stent is anew-generation hybrid dual-layer stent that has been designed to provide less thrombogenicity and to prevent peri- and postinterventional emboli. The aim of the study is to evaluate the safety and efficacy of the CGuard stent for the acute treatment of occlusion or high-grade stenosis of the extracranial internal carotid artery (ICA) in patients with acute ischemic stroke (AIS) with and without concomitant intracranial large vessel occlusion (LVO). All patients who underwent emergent carotid artery stenting (CAS) with the CGuard stent were identified and analyzed from the stroke registries from four tertiary German stroke centers. Clinical, procedural, and imaging data were evaluated. Stent patency within 72 h, intracranial hemorrhage, and modified Rankin score (mRS) at discharge were the safety and efficacy end points. Overall, ninety-six patients were included (mean age70.2 ± 11.8, 66males (68.8%), median NIHSS score at admission 11 (7-17), IVlysis: n = 44 (45.8%)). Stent placement was successful in all patients. Eighty-three (86.4%) patients had tandem occlusions. In-stent occlusion occurred in 5patients (5.2%) and 3patients developed early in-stent stenosis (3.1%). Median mRS at discharge was 2 (1-4). In this multicenter study, the use of the dual-layer CGuard stent for emergent CAS, particularly in tandem occlusions, was safe and resulted in low rates of in-stent occlusions.

Dual- vs single-layer stents for endovascular treatment of symptomatic and asymptomatic internal carotid artery stenosis

BackgroundsPlaque protrusion is a common event among carotid artery stenting (CAS) patients and increases ischemic complication risk. Dual-layer stents (DLS) with micromesh technology may offer greater plaque protection compared to single-layer stents (SLS), but few data are available. The aim of the study is to compare clinical outcomes at 12 months for asymptomatic and symptomatic patients treated for primary CAS with DLS or SLS in a high-volume center. MethodsA retrospective analysis of consecutive symptomatic and asymptomatic patients treated with primary CAS for internal carotid artery (ICA) stenosis, with either DLS or SLS between 2015 and 2019, was performed. Primary endpoints included rates of ipsilateral transient ischemic attacks (TIA)/stroke and death within 1-year from CAS. Secondary endpoints included patency rates and survival according to stent type. ResultsOf the 301 patients who met inclusion criteria (74.8 % male; 73.6 mean age ± 8.7 years), most patients were asymptomatic (77.4 %). Among all patients DLS was most frequently deployed (66 %); also, among asymptomatic (62 %) and symptomatic patients (81 %), p < 0.01. Symptomatic patients had less comorbidities and severe disease than asymptomatic patients.Six peri-operative strokes were recorded and, within 1 year, 2 additional strokes were registered among symptomatic patients treated with SLS. No post-operative strokes were encountered in the DLS group (p = 0.04) among symptomatic patients. Higher rates of TIA were observed among asymptomatic patients treated with DLS compared to SLS while rates of TIA were reduced among symptomatic patients treated with DLS.There were no differences in patency rates for DLS and SLS in symptomatic and asymptomatic patients. Primary patency was similar among DLS stent types but differed among SLS stent types (p = 0.01).At a mean follow-up of 27 months ±17.6, survival was comparable between DLS and SLS groups (p = 0.98). ConclusionCAS with DLS seems to reduce the risk of post-procedural stroke for symptomatic patients compared to SLS whilst the choice of stent did not influence ipsilateral TIA, survival or patency rates. These data require confirmation from larger, randomized, prospective studies.

Early Stent Patency After Endovascular Therapy for Tandem or Isolated Carotid Steno-Occlusive Disease

Early Stent Patency After Endovascular Therapy for Tandem or Isolated Carotid Steno-Occlusive Disease

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

Abstract 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 &gt;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.

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.

Comparison of Restenosis Risk in Single-Layer versus Dual-Layer Carotid Stents: A Duplex Ultrasound Evaluation.

The aim of this study was to report intermediate-term results of duplex ultrasound follow-up of carotid artery stenting performed with the dual-layer stent as compared to concurrent patients treated with other commercially available single-layer carotid stents. Asingle centre, retrospective, nonrandomized study including 162 non-consecutive patients with 199 implanted carotid stents treated over a 7-year period was conducted. Patients with at least one ultrasound examination after treatment were included. Procedural and follow-up data for patients treated with the dual-layer stent implantation (83 stents) vs first-generation carotid stents implantations (116 stents) were compared. The median follow-up time was 24.0months (IQR 10-32months) for dual-layer stents and 27.5months (IQR 10.3-59months) for single-layer stents. The rate of severe restenosis was significantly higher in the dual-layer stent group than in the single-layer group (13.3% [11/83] vs 3.4% [4/116], p = 0.01). Seven reinterventions were performed in 5 patients with dual-layer stents. The rate of reintervention was significantly higher compared to no reinterventions in single-layer stents (6% [5/83] vs 0% [0/116], p = 0.012). Patients with restenosis had significantly higher presence of dyslipidaemia (100% [12/12] vs 63.3% [95/150], p = 0.009). In this real-world cohort of patients undergoing carotid artery stenting, the patients treated with low-profile dual-layer micromesh stent showed higher rates of restenosis and reinterventions compared to first-generation single-layer stents.

Effectiveness and safety of dual-layer stents in carotid artery disease: a systematic review.

Carotid artery stenting (CAS) has emerged as a minimally invasive alternative to carotid endarterectomy (CEA) in atherosclerotic carotid artery disease, even though the risk for procedural stroke after CAS remains significantly higher. Recently, in order to reduce embolic cerebral events after CAS, a new generation of dual-layer stents (DLS) has been developed. This review aimed to perform a detailed analysis of the available evidence on safety and efficacy of DLS in both symptomatic and asymptomatic atherosclerotic carotid artery stenosis. A systematic review was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The primary endpoint was the 30-day rate of myocardial infarction (MI), stroke and death. Secondary outcomes included rate and timing of stent occlusion/restenosis. A total of 20 articles with 1193 patients were included. Thirty-day MI ranged from 0-5%, 30-day stroke ranged from 0-10.5% and 30-day mortality ranged from 0-10%. Stent occlusion rate ranged from 0-52.4%, the majority of which occurred intraprocedurally (N.=50; 61.7%), in emergency treated patients. The incidence of new ipsilateral cerebral ischemic lesions after CAS with DLS was reported in five studies, ranging from 5.5-37%. Despite the theoretic advantage of reducing the risk for procedural embolic events when compared to conventional stents, high quality evidence is scarce. Also, safety issues regarding DLS in the emergency setting have been raised, particularly for thrombotic complications. Additional data from well-designed Randomized Controlled Trials are needed to assert the true value of DLS.

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 Carotid Stent Thrombosis – What to do Now? Overview of Evidence on Risk Factors and Early Management Over the Last Two Decades

Introduction - Acute carotid stent thrombosis (ACST) occurring in the first hours post-procedure is an exceedingly rare complication of carotid artery stenting but it is potentially devastating. The European Society for Vascular Surgery updated guidelines state thrombolysis and intravenous abciximab may be effective, but provide no specific recommendations. The aim of this review was to evaluate current literature on ACST, identifying all reported cases over the last two decades, with the final purpose of reporting on predictive factors and early management. Methods - A systematic review and meta-analysis was conducted according to the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Results - A total of 464 potentially relevant articles were initially selected. After reviewing records, at title or abstract level, a total of 29 articles with 60 patients were included. Twelve studies reported on ACST incidence rate in their cohorts ranging from 0.36% to as high as 33%. Considering aetiology, antiplatelet non-compliance/resistance, carotid artery dissection, plaque protrusion and long lesions needing two overlapping stents were the most reported. Emergency setting procedures seem associated with greater risk for ACST reaching as high as 5.6-33% incidence. Dual layer stents were associated with greater risk for ACST (45% Vs 3.7%; p=0.0001; OR=21.3). Use of a second overlapping stent as a bail out procedure due to dissection, malposition or long lesions was correlated with increased risk (7.3% Vs 0.002%). Long stenotic lesions (mm) and stent length (cm) were also risk factors (22.9±6.83 Vs 14.2±6.42; p=0.0034 and 3.8±0.4 Vs 2.8±0.86; p=0.0055 respectively). ACST was associated with neurologic status deterioration in 56.7%. Time to symptoms and/or ACST diagnosis had a median of 1.5 hours, with 30% occurring intra-procedural. Endovascular treatment was the most common approach to intraprocedural ACST: mechanical thrombectomy with or without concomitant facilitated thrombolysis (n=10) and stent-in-stent (n=2). Surgical options included carotid endarterectomy with stent explantation (n=9) and mechanical thrombectomy of embolus (n=1). Carotid endarterectomy was a bail-out after failed endovascular treatment in 2 cases. In asymptomatic ACST conservative management was rather unanimous. Conclusion - Incidence rate for ACST is greater in emergency settings, in neurologically unstable patients. Also, antiplatelet noncompliance, antiplatelet resistance, long stenotic lesions, use of more than one stent and dual layer stents are associated with increased risk. Decision on the best approach depends if ACST occurs intraprocedural or afterwards, on the development of neurologic status deterioration and on centre´s experience. Additional studies must be undertaken to better define optimal management.

PCV46 BUDGET IMPACT OF A DUAL-LAYER STENT RETRIEVER (DLSR) IN THE TREATMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE (AIS) FROM HOSPITAL'S PERSPECTIVE IN FRANCE AND SWEDEN

Mechanical thrombectomy (MT) is guideline recommended to treat acute ischemic stroke. The adoption of a dual-layer stent retriever (DLSR) (EMBOTRAP®, Cerenovus) in MT has recently been evaluated in a budget impact analysis incorporating clinical outcomes from a performance goal-based single-arm study and the corresponding RCTs. It was conducted from the perspective of NHS England. Here, we evaluate the transferability into French and Swedish health care systems. The model compared economic impact of increased adoption of DLSR from the hospital´s perspective of France (DLSR: 2.0% to 9%) and Sweden (DSLR: 47.5% to 70%). Clinical outcomes (distribution of modified Ranking Score (mRS)) with DLSR compared to other MT devices were obtained from the ARISE II study and HERMES, a large meta-analysis. Case volume and country-specific costs for length of stay (LOS) were obtained from published literature; device adoption rates and technology costs from market research; procedural costs were assumed to only differ between cost for technologies. LOS depending on mRS, was informed by a post hoc analysis of ARISE II. Sensitivity analyses were conducted. Costs were reported in 2018 SEK (Sweden), Euros (France). Among 4,777 patients annually treated with MT in France, 71 additional patients achieved good functional outcomes (mRS 0-2) in the scenario with increased use of the DLSR. Costs for MT patients in France were €85,904 lower in the scenario with increased use of the DLSR (€20,662,040 vs. €20,747,944). Among 408 patients annually treated in Sweden, 20 additional patients achieved good functional outcomes and costs were SEK504,525 lower in the scenario with increased use of the DLSR (SEK26,973,618 vs. SEK27,478,143). The adaptation of the UK budget impact analysis to France and Sweden generated directionally comparable results. Additional potential clinical benefits provided by increased adoption of a DLSR may be accompanied by cost-savings.

PCV43 BUDGET IMPACT ANALYSIS OF A DUAL-LAYER STENT RETRIEVER FOR THE TREATMENT OF LARGE VESSEL STROKES: A U.S. PAYER PERSPECTIVE

Mechanical thrombectomy (MT) is recommended for endovascular treatment of large vessel strokes; however, economic differences amongst MT devices have not been evaluated. This study estimated the budget impact associated with increased adoption of a dual-layer stent retriever (DLSR), EMBOTRAP®, for large vessel strokes from a U.S. payer perspective. The analysis compared economic outcomes in 150 patients treated in a “current scenario” (device mix: 9% DLSR and 91% other MT devices) to a “future scenario” with increased adoption of the DLSR (30% DLSR and 70% other MT devices) over a 90-day time-horizon. Procedural costs were limited to device costs, as other costs were assumed to be similar. Acute healthcare costs based on 90-day functional outcomes using the modified Rankin Scale (mRS) were analyzed. The proportions of patients achieving each mRS level with the DLSR and other MT devices were obtained from published literature (ARISE II [n=217] for DLSR and SWIFT PRIME [n=98] and TREVO 2000 [n=711] for other MT devices). Acute 90-day healthcare costs per mRS level were based on a 2018 U.S. cost-effectiveness publication. Case volume, device mix, and device costs were obtained from market research. Deterministic sensitivity analyses were conducted. Costs were reported as 2018 U.S. dollars. Among 150 patients, 91 and 93 patients achieved good functional outcomes (mRS 0-2) in the “current” and “future” scenarios, respectively. Both device and acute healthcare costs were lower in the “future scenario”; total costs were $3,593,125 in the “current” and $3,553,632 in the “future” scenarios, translating to savings of $39,493 over 90-days ($263 per patient). Given the absence of head-to-head trials to inform functional outcomes, a naive comparison was used and is a key limitation of the study. In addition to potential clinical benefits, increased adoption of the DLSR for large vessel strokes may lead to cost-savings for the U.S. payer.

Evaluating the effectiveness and safety of the carotid Casper-RX stent for tandem lesions in acute ischemic stroke

IntroductionA new generation of carotid artery stents that use a dual micromesh layer to reduce embolic events during carotid artery stenting has recently been introduced. We aimed to analyze the...

PMD33 - BUDGET IMPACT ANALYSIS OF A DUAL-LAYER STENT RETRIEVER (DLSR) FOR THE TREATMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE (AIS) IN ENGLAND

The National Institute for Health and Care Excellence (NICE) recommends mechanical clot retrieval (MCR) for the treatment of acute ischemic stroke (AIS). Recently, a large clinical trial in AIS patients treated with a dual-layer stent retriever (DLSR) reported excellent functional independence outcomes, an important goal of stroke therapy that impacts patient quality of life. While the clinical benefits of MCR have been demonstrated, studies assessing the economic implications of technology selection are limited. Thus, this study estimated the budget impact of adopting a DLSR for patients with AIS from a 12-month National Health Service (NHS) perspective. The analysis compared a cost scenario considering a DLSR to a scenario with single-layer stent retrievers only, assuming a 25% adoption rate of DSLR. Acute (90-day) healthcare costs based on patient functional independence measured using the modified Rankin Scale (mRS) were included. Index procedure costs were limited to the acquisition cost of MCR technology, as evidence indicates other procedural resources to be similar between MCR devices. Functional outcomes, acute costs per mRS, and MCR technology acquisition costs were obtained from peer-reviewed literature. Case volume, treatment mix, and cost of the DLSR were obtained from market research data. Costs were reported as 2018 GBP. Among 655 patients treated with MCR over 12 months, 246 patients achieved good functional outcomes (mRS 0-2) in the scenario without the DLSR, compared with 294 patients in the scenario with the DLSR. Total 90-day costs in the scenario with the DLSR were £401,738 lower than the scenario with the DLSR (£10,127,235 vs. £10,528,973). In this analysis, adoption of a DLSR for AIS was associated with improvements in patient functional status. Functional independence may be achieved in 20% more patients in a scenario with the DLSR , which may translate to cost-savings for the NHS.

P436Durability of stroke prevention using a dual-layer stent system in carotid revascularization in symptomatic and increased-stroke-risk asymptomatic patients: 12-month evidence from the PARADIGM study

P436Durability of stroke prevention using a dual-layer stent system in carotid revascularization in symptomatic and increased-stroke-risk asymptomatic patients: 12-month evidence from the PARADIGM study

Acute Occlusions of Dual-Layer Carotid Stents After Endovascular Emergency Treatment of Tandem Lesions.

A new generation of carotid artery stents that uses a second micromesh layer to reduce embolic events during carotid artery stenting has recently been introduced. The purpose of this study was to compare acute occlusion rates of these new dual-layer stents with those of single-layer stents in the setting of emergency carotid artery stenting with intracranial mechanical thrombectomy in acute ischemic stroke. Consecutive patients with acute tandem (intra- and extracranial) lesions of the anterior circulation who were endovascularly treated at our institution were identified from our registry of neuroendovascular interventions. Clinical, angiographic, and neuroimaging data were analyzed. End points included acute occlusions of the carotid stents (within 72 hours after stenting) and symptomatic intracerebral hemorrhage. Forty-seven patients were included. Dual-layer stents (n=20) had a significantly higher rate of acute occlusions than single-layer stents (n=27; 45% versus 3.7%; P=0.001; odds ratio, 21.3; 95% confidence interval, 2.4-188.4). There were no significant differences in the rates of patients who had any antiplatelet or dual antiplatelet medication before admission, in the rates of postinterventional symptomatic intracerebral hemorrhage, the mean National Institutes of Health Stroke Scale scores at admission, or the modified Rankin Scale scores at discharge. The recently introduced dual-layer stents have a higher risk of acute occlusion compared with single-layer stents in the treatment of acute stroke.

Optimal coating method for a dual-layer stent with sirolimus and alpha-lipoic acid in a porcine coronary restenosis model

The aim of this study was to evaluate the optimal method for coating a double-layer polymer coronary stent with sirolimus and alpha-lipoic acid (ALA) in a porcine coronary overstretch restenosis model. Pigs were randomized into three groups, in which the coronary arteries (10 in each group) were stented with a dual-layer stent with an inner layer of ALA and an outer layer of sirolimus (IAOS, n=10), a dual-layer stent with an inner layer of sirolimus and an outer layer of ALA (ISOA, n=10), or a commercial drug-eluting stent (biolimus-eluting stent, BES, n=10). Histopathological analysis was performed 28 days after stenting. There were no significant differences among the three groups in injury and inflammation scores. There were significant differences among the three groups in neointimal area (1.1±0.16 mm2 for IAOS vs. 1.3±0.41 mm2 for ISOA vs. 1.9±0.50 mm2 for BES, p<0.0001), and percentage of stenosis area (21.4±3.08% for IAOS vs. 29.9±7.72% for ISOA vs. 38.2±9.08% for BES, p<0.0001). Regarding the percentage of stenosis area, microcomputed tomography revealed significant differences between the three groups (23.8±3.51% for IAOS vs. 28.9±4.65% for ISOA vs. 36.4±8.07% for BES, p<0.05). Compared with commercial stent placement, both IAOS and ISOA resulted in significant inhibition of neointimal formation in a porcine coronary restenosis model. In addition, IAOS was more effective than ISOA in preventing anti-neointimal hyperplasia after stenting.

A numerical framework for the mechanical analysis of dual-layer stents in intracranial aneurysm treatment

Dual-layer stents and multi-layer stents represent a new paradigm in endovascular interventions. Multi-layer stents match different stent designs in order to offer auxiliary functions. For example, dual-layer stents used in the endovascular treatment of intracranial aneurysms, like the FREDTM (MicroVention, CA) stent, combine a densely braided inner metallic mesh with a loosely braided outer mesh. The inner layer is designed to divert blood flow, whereas the outer one ensures microvessels branching out of the main artery remain patent. In this work, the implemented finite element (FE) analysis identifies the key aspects of dual-stent mechanics. In particular, dual-layer stents used in the treatment of intracranial aneurysms require the ability to conform to very narrow passages in their closed configuration, while at the same time they have to provide support and stability once deployed. This study developed a numerical framework for the analysis of dual-layer stents for endovascular intracranial aneurysm treatment. Our results were validated against analytical methods. For the designs considered, we observed that foreshortening was in average 37.5%±2.5%, and that doubling the number of wires in the outer stent increased bending moment by 23%, while halving the number of wires of the inner stent reduced von Mises stress by 2.3%. This framework can be extended to the design optimization of multi-layer stents used in other endovascular treatments.

Hazel Wilkinson

<h3>Introduction</h3> A new generation of carotid artery stents that use a dual micromesh layer to reduce embolic events during carotid artery stenting has recently been introduced. We aimed to analyze...