Midterm Clinical Outcomes and Hemodynamic Patency of Standalone Cguard Micronet-Covered Carotid Stenting in Symptomatic Carotid Artery Stenosis: A Prospective Single-Center Study

Abstract

Background: Carotid artery stenting (CAS) is an established alternative to carotid endarterectomy for selected patients with symptomatic carotid artery stenosis. Conventional CAS commonly incorporates embolic protection devices to reduce procedural cerebral embolization; however, these devices may increase procedural complexity and are associated with device-related limitations. The CGuard MicroNET-covered carotid stent was developed to provide continuous plaque coverage and may reduce embolic complications without the routine use of adjunctive embolic protection devices. This study evaluated the safety and midterm efficacy of the CGuard MicroNET-covered stent when used as a standalone embolic protection strategy.

Methods: This prospective single-center observational study included 117 consecutive patients with symptomatic carotid artery stenosis who underwent CAS using the CGuard MicroNET-covered stent between January 2018 and December 2023 without distal filter or proximal flow-reversal protection. The primary safety endpoint was stroke within 30 days. The primary efficacy endpoint was primary stent patency at 12 months. All patients underwent diffusion-weighted magnetic resonance imaging within 48 hours after the procedure and standardized clinical and imaging follow-up for 12 months.

Results: Technical success was achieved in all 117 procedures (100%). No patient experienced periprocedural stroke, myocardial infarction, or death within 30 days. One patient (0.85%) demonstrated a new asymptomatic diffusion-weighted imaging lesion. Twelve-month follow-up was available for 110 patients (94.0%). Primary patency was maintained in 108 patients (98.4%), and no patient experienced ipsilateral stroke or required target lesion revascularization during follow-up. Adherence to the prescribed dual antiplatelet therapy regimen was significantly associated with maintained primary patency (OR 8.41, 95% CI 4.12–15.68; p < 0.001).

Conclusions: The CGuard MicroNET-covered carotid stent demonstrated a high technical success rate, low periprocedural complication rate, and durable midterm patency when used without adjunctive embolic protection devices in this prospective cohort. These findings support the feasibility of standalone mesh-covered carotid stenting in selected patients with symptomatic carotid artery stenosis. Larger multicenter comparative studies with longer follow-up are required to confirm these findings.