Background: Single-cohort studies suggest that second-generation stents (SGS; “mesh
stents”) may improve carotid artery stenting (CAS) outcomes by limiting peri- and postprocedural
cerebral embolism. SGS differ in the stent frame construction, mesh material, and design, as well as in
mesh-to-frame position (inside/outside). Objectives: To compare clinical outcomes of SGS in relation
to first-generation stents (FGSs; single-layer) in CAS. Methods: We performed a systematic review and
meta-analysis of clinical studies with FGSs and SGS (PRISMA methodology, 3302 records). Endpoints
were 30-day death, stroke, myocardial infarction (DSM), and 12-month ipsilateral stroke (IS) and
restenosis (ISR). A random-effect model was applied. Results: Data of 68,422 patients from 112 eligible
studies (68.2% men, 44.9% symptomatic) were meta-analyzed. Thirty-day DSM was 1.30% vs. 4.11%
(p < 0.01, data for SGS vs. FGS). Among SGS, both Casper/Roadsaver and CGuard reduced
30-day DSM (by 2.78 and 3.03 absolute percent, p = 0.02 and p < 0.001), whereas the Gore stent
was neutral. SGSs significantly improved outcomes compared with closed-cell FGS (30-day stroke
0.6% vs. 2.32%, p = 0.014; DSM 1.3% vs. 3.15%, p < 0.01). At 12 months, in relation to FGS,
Casper/Roadsaver reduced IS (−3.25%, p < 0.05) but increased ISR (+3.19%, p = 0.04), CGuard
showed a reduction in both IS and ISR (−3.13%, −3.63%; p = 0.01, p < 0.01), whereas the Gore stent
was neutral. Conclusions: Pooled SGS use was associated with improved short- and long-term clinical results of CAS. Individual SGS types, however, differed significantly in their outcomes, indicating a
lack of a “mesh stent” class effect. Findings from this meta-analysis may provide clinically relevant
information in anticipation of large-scale randomized trials.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:88426 |
| Date | 04 December 2023 |
| Creators | Mazurek, Adam, Malinowski, Krzysztof, Rosenfield, Kenneth, Capoccia, Laura, Speziale, Francesco, de Donato, Gianmarco, Setacci, Carlo, Wissgott, Christian, Sirignano, Pasqualino, Tekieli, Lukasz, Karpenko, Andrey, Kuczmik, Waclaw, Stabile, Eugenio, Metzger, David Christopher, Amor, Max, Siddiqui, Adnan H., Micari, Antonio, Pieniazek, Piotr, Cremonesi, Alberto, Schofer, Joachim, Schmidt, Andrej, Musialek, Piotr |
| Publisher | MDPI |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:article, info:eu-repo/semantics/article, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 2077-0383, 10.3390/jcm11164819 |
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