• Kiyofumi Yamada, Shinichi Yoshimura, Masatomo Miura, Takuya Kanamaru, Seigo Shindo, Kazutaka Uchida, Manabu Shirakawa, Masahiko Shibuya, Takahiro Imanaka, Masaharu Ishihara, Tohru Masuyama, Reiichi Ishikura, and Masanori Kawasaki.
• Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.
• World Neurosurg. 2017 Sep 1; 105: 321-326.

BackgroundOne disadvantage of carotid artery stenting (CAS) is a high incidence of distal embolism (DE) during or after the procedure. Patients with unstable plaque are considered at high risk for DE and plaque protrusion (PP) after stent placement, which can cause postprocedural ischemic complications. This study was conducted to compare the rate and size of PP between the CASPER stent, a new-generation double-layer micromesh stent, and conventional stents as assessed by optical frequency domain imaging (OFDI), and also to evaluate the efficacy of CAS with the CASPER stent in cases with unstable plaque.MethodsThe study group comprised 46 consecutive patients with unstable plaque, identified on magnetic resonance imaging, undergoing CAS with OFDI image acquisition. Cross-sectional OFDI images within the stented segments were evaluated at 0.125-mm intervals, and the rate and size of PP were compared between the CASPER stent and conventional stents.ResultsThe CASPER stent was used in 9 patients. No procedural complications occurred. On OFDI analysis, the presence of PP was apparently lower in CASPER stent group compared with the conventional stent group (44% vs. 88%; P = 0.022). In addition, mean PP area was significantly smaller in the CASPER stent group (mean PP area, 0.013 ± 0.034 mm2 vs. 0.057 ± 0.09 mm2; P = 0.006).ConclusionsOn OFDI evaluation after CAS, the degree of PP was significantly smaller in the CASPER stent group compared with the conventional stent group. This result provides new insight into the use of CAS to treat carotid artery stenosis with unstable plaque.Copyright © 2017 Elsevier Inc. All rights reserved.

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