Comparative evaluation of the CGuard dual−layer stent and Carotid Wallstent for elective carotid artery stenting: a retrospective multicenter study

Purpose This study aims to evaluate the safety and efficacy of the CGuard dual-layer stent with its mesh embolic protection system (EPS) in elective cases for treatment of internal carotid artery stenosis and compares it to the Carotid Wallstent as benchmark. Methods In this retrospective, multicenter study, we analyzed data from consecutive patients who underwent carotid artery stenting with CGuard at two high-volume neurointerventional centers and compared them with prior consecutive patients treated with Carotid Wallstent (CWS), with and without a balloon guiding catheter (BGC) as protection, at the same institutions. Patient demographics, procedural details, clinical complications, early in-stent thrombosis and occlusion rates, and late follow-up restenosis rates were assessed. Results A total of 428 patients were treated, 144 with the CGuard stent, 203 with CWS + BGC and 83 with CWS-BGC, the majority of patients for symptomatic stenoses. Technical success was achieved in 98.6% of CGuard patients. No clinical complications were observed in CGuard patients, however the clinical complication rate was 2.96% (6/203) for CWS + BGC and 4.94% (4/83) for CWS-BGC patients ( p = 0.052). The in-hospital stent occlusion rate was 0.69% (1/144) for CGuard and 2.1% (6/286) in CWS ± BGC patients ( p = 0.49). On long-term follow-up (mean 9.9 months) the CGuard demonstrated a comparatively low rate of restenosis (6.25%) and retreatment (2.1%). Conclusion The CGuard dual-layer stent was safe and effective for carotid artery stenting in our series. Its design appears to contribute to a low risk of periprocedural complications, high technical success rate, while maintaining restenosis rates comparable to the Carotid Wallstent.