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  • Dual-layered stents reduce cerebral embolism compared with first-generation stents during carotid stenting of high lipid core plaque lesions

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Ischemic stroke
Original research
Dual-layered stents reduce cerebral embolism compared with first-generation stents during carotid stenting of high lipid core plaque lesions
  1. Ichiro Nakagawa,
  2. Masashi Kotsugi,
  3. Shohei Yokoyama,
  4. Ryosuke Maeoka,
  5. Takanori Furuta,
  6. Haku Tanaka,
  7. Yasuhiro Takeshima,
  8. Ryosuke Matsuda,
  9. Shuichi Yamada,
  10. Hiroyuki Nakase
  1. Department of Neurosurgery, Nara Medical University, Kashihara, Japan
  1. Correspondence to Dr Ichiro Nakagawa, Department of Neurosurgery, Nara Medical University, Kashihara, Japan; nakagawa{at}naramed-u.ac.jp

Abstract

Background Periprocedural lipid core plaque (LCP) has been detected in carotid arteries assessed by catheter-based near-infrared spectroscopy (NIRS). High LCP is associated with cerebral embolism after carotid artery stenting (CAS) using a first-generation stent. We aimed to evaluate whether dual-layered stents reduce embolic infarcts in patients with high LCP and change of lipid signal as assessed by NIRS during CAS.

Methods Participants comprised 210 consecutive patients undergoing CAS. The study was divided into two distinct periods, with first-generation closed-cell stents used in the earlier period and dual-layered stents used in the later period. NIRS was performed at baseline, after stent implantation, and after balloon post-dilatation to analyze maximal lipid core burden index at minimal luminal area (max-LCBIMLA).

Results The ipsilateral cerebral embolism rate was significantly lower with dual-layered stents (9%) than with first-generation stents (33%, p<0.001), particularly with highly lipidic lesions (12% vs 60%, p<0.001). On multivariate logistic regression analysis, high LCP and first-generation stent usage were factors related to ipsilateral cerebral embolism (both p<0.001; OR 8.28 (95% CI 3.49 to 19.64) and OR 8.07 (95% CI 2.33 to 27.93), respectively). Max-LCBIMLA decreased significantly after stenting in both groups (both p<0.01) and max-LCBIMLA after balloon post-dilatation was significantly lower with dual-layered stents (22.4±65.6) than with first-generation stents (124.2±208.2; p=0.006).

Conclusions Dual-layered stents reduce embolic infarcts in patients with highly lipidic plaque lesions as assessed by NIRS who undergo CAS. Dual-layered stents significantly reduced NIRS-derived lipid signals after stenting.

  • Stent
  • Vessel Wall
  • Stenosis
  • Intervention
  • Atherosclerosis

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2023-020106

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors IN, MK and SY conceived the study, drafted and edited the manuscript. RM, TF, HT, YT, RMd, SYa, and HN provided critical editing and guidance for the manuscript. IN is responsible for the overall content as guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.