A multi-center study of the MicroNET-covered stent in consecutive patients with acute carotid-related stroke: SAFEGUARD-STROKE

• Published in: Postępy w kardiologii interwencyjnej 2024-06, Vol.20 (2), p.172-193
• Main Authors: Tekieli, Lukasz, Afanasjev, Andrej, Mazgaj, Maciej, Borodetsky, Vladimir, Sievert, Kolja, Ruzsa, Zoltan, Knapik, Magdalena, Širvinskas, Audrius, Mazurek, Adam, Dzierwa, Karolina, Sanczuk, Thomas, Mosenko, Valerija, Urbanczyk-Zawadzka, Malgorzata, Trystula, Mariusz, Paluszek, Piotr, Wiewiorka, Lukasz, Stefaniak, Justyna, Pieniazek, Piotr, Slautaitė, Inga, Kwiatkowski, Tomasz, Mackevičius, Artūras, Teitcher, Michael, Sievert, Horst, Grunwald, Iris Q, Musialek, Piotr
• Format: Article
• Language: English
• Subjects: carotid artery stenting; carotid stenosis; carotid-related stroke; cerebral protection devices; cguard; clinical outcomes; mechanical reperfusion; mechanical thrombectomy; micronet-covered stent; Original Paper; stent optimization; stroke endovascular treatment
• ISSN: 1734-9338; 1897-4295
• DOI: 10.5114/aic.2024.140963

Acute carotid-related stroke (CRS), with its large thrombo-embolic load and large volume of affected brain tissue, poses significant management challenges. First generation (single-layer) carotid stents fail to insulate the athero-thrombotic material; thus they are often non-optimized (increasing thrombosis risk), yet their use is associated with a significant (20-30%) risk of new cerebral embolism. To evaluate, in a multi-center multi-specialty investigator-initiated study, outcomes of the MicroNET-covered (cell area ≈ 0.02-0.03 mm ) carotid stent (CGuard, InspireMD) in consecutive CRS patients eligible for emergency recanalization. Treatment, other than study device use, was according to center/operator routine. Seventy-five patients (age 40-89 years, 26.7% women) were enrolled in 7 interventional stroke centers. The median Alberta Stroke Program Early CT Score (ASPECTS) was 9 (6-10). Study stent use was 100% (no other stent types implanted); retrograde strategy predominated (69.2%) in tandem lesions. Technical success was 100%. Post-dilatation balloon diameter was 4.0 to 8.0 mm. 89% of patients achieved final modified Thrombolysis in Cerebral Infarction (mTICI) 2b-c/3. Glycoprotein IIb/IIIa inhibitor use as intraarterial (IA) bolus + intravenous (IV) infusion was an independent predictor of symptomatic intracranial hemorrhage (OR = 13.9, 95% CI: 5.1-84.5, < 0.001). The mortality rate was 9.4% in-hospital and 12.2% at 90 days. Ninety-day mRS0-2 was 74.3%, mRS3-5 13.5%; stent patency was 93.2%. Heparin-limited-to-flush predicted patency loss on univariate (OR = 14.3, 95% CI: 1.5-53.1, < 0.007) but not on multivariate analysis. Small-diameter balloon/absent post-dilatation was an independent predictor of stent patency loss (OR = 15.2, 95% CI: 5.7-73.2, < 0.001). This largest to-date study of the MicroNET-covered stent in consecutive CRS patients demonstrated a high acute angiographic success rate, high 90-day patency and favorable clinical outcomes despite variability in procedural strategies and pharmacotherapy (SAFEGUARD-STROKE NCT05195658).