| Title: |
Clinical Outcomes of Second- versus First-Generation Carotid Stents: A Systematic Review and Meta-Analysis |
| Authors: |
Mazurek A.; Malinowski K.; Rosenfield K.; Capoccia L.; Speziale F.; de Donato G.; Setacci C.; Wissgott C.; Sirignano P.; Tekieli L.; Karpenko A.; Kuczmik W.; Stabile E.; Metzger D. C.; Amor M.; Siddiqui A. H.; Micari A.; Pieniazek P.; Cremonesi A.; Schofer J.; Schmidt A.; Musialek P. |
| Contributors: |
Mazurek, A.; Malinowski, K.; Rosenfield, K.; Capoccia, L.; Speziale, F.; de Donato, G.; Setacci, C.; Wissgott, C.; Sirignano, P.; Tekieli, L.; Karpenko, A.; Kuczmik, W.; Stabile, E.; Metzger, D. C.; Amor, M.; Siddiqui, A. H.; Micari, A.; Pieniazek, P.; Cremonesi, A.; Schofer, J.; Schmidt, A.; Musialek, P. |
| Publication Year: |
2022 |
| Collection: |
Università degli Studi di Siena: USiena air |
| Subject Terms: |
carotid artery stenting; stent design; stroke prevention; systematic review and meta-analysi; “mesh-covered” dual-layer stents |
| Description: |
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. |
| Document Type: |
article in journal/newspaper |
| File Description: |
ELETTRONICO |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/36013058; info:eu-repo/semantics/altIdentifier/wos/WOS:000845802300001; volume:11; issue:16; numberofpages:24; journal:JOURNAL OF CLINICAL MEDICINE; https://hdl.handle.net/11365/1276732; https://pmc.ncbi.nlm.nih.gov/articles/PMC9409706/ |
| DOI: |
10.3390/jcm11164819 |
| Availability: |
https://hdl.handle.net/11365/1276732; https://doi.org/10.3390/jcm11164819; https://www.mdpi.com/2077-0383/11/16/4819; https://pmc.ncbi.nlm.nih.gov/articles/PMC9409706/ |
| Rights: |
info:eu-repo/semantics/openAccess |
| Accession Number: |
edsbas.8CF7F7B4 |
| Database: |
BASE |