2 0
1 6
P Musialek @ i-MEET 2017
T.W., man 69 yo
critical LICA stenosis
L haemisph stroke 5mo
fundamental Qs:
LICA
(with haemorrh. transformation)
2 0
1 6
P Musialek @ i-MEET 2017
T.W., man 69 yo
critical LICA stenosis
L haemisph stroke 5mo
2 fundamental Qs:
whether ?(to intervene or not)
how ?
LICA .
.
2 0
1 6
E.W., woman, 58 y, TWO recent ( 20d and 5d )
R haemisphericminor strokes despite OMT !
P Musialek @ i-MEET 2017
2 0
1 6
E.W., woman, 58 y, TWO recent ( 20d and 5d )
R haemisphericminor strokes despite OMT !
P Musialek @ i-MEET 2017
E.W., woman, 58 y, TWO recent ( 20d and 5d )
R haemisphericminor strokes despite OMT !
P Musialek @ i-MEET 2017
RICA
E.W., woman, 58 y, TWO recent ( 20d and 5d )
R haemisphericminor strokes despite OMT !
P Musialek @ i-MEET 2017
RICA
whether ?(to intervene or not)
how ?
.
.
2 0
1 6
E.W., woman, 58 y, TWO recent ( 20d and 5d )
R haemisphericminor strokes despite OMT !
P Musialek @ i-MEET 2017
T.W., man 69 yo
critical LICA stenosis
L haemisph stroke 5mo
LICA RICA
CREST
30 d
P Musialek @ i-MEET 2017
Who agreesthis indicates
no meaningful futurefor carotid stenting ?
2 0
1 6
E.W., woman, 58 y, TWO recent ( 20d and 5d )
R haemisphericminor strokes despite OMT !
P Musialek @ i-MEET 2017
T.W., man 69 yo
critical LICA stenosis
L haemisph stroke 5mo
LICA RICA
2 0
1 6
E.W., woman, 58 y, TWO recent ( 20d and 5d )
R haemisphericminor strokes despite OMT !
P Musialek @ i-MEET 2017
T.W., man 69 yo
critical LICA stenosis
L haemisph stroke 5mo
LICA RICA
TCAR with CGuard: The perfect wayto protect brain!
Piotr Musialek, MD DPhilMariusz Trystula, MD PhD
Jagiellonian University Dept. of Cardiac & Vascular Diseasesand Dept. Vascular Surgery, John Paul II Hospital, Krakow, Poland
– are there any limitations?
2 0
1 6
E.W., woman, 58 y, TWO recent ( 20d and 5d )
R haemisphericminor strokes despite OMT !
P Musialek @ i-MEET 2017
T.W., man 69 yo
critical LICA stenosis
L haemisph stroke 5mo
LICA RICA
The Problem of Conventional Carotid Stents
Image courtesy Joan Rigla, MD PhD; Perceptual Imaging Lab, Univerity of Barcelona
Human carotid artery treated using a conventional stent; OCT
P Musialek @ i-MEET 2017
Timing of neuro-embolic events after CAS
D. McCormick TCT 2012, modified
40-80%stroke timing with CAS in CAPTURE and CREST
Timing of neuro-embolic events after CAS
D. McCormick TCT 2012, modified
40-80%*
post-procedural strokeswith CAS in CAPTURE
and CREST
*
CEA excludes the plaque
In CAS, the stent shouldexclude the plaque too
.
.
2 0
1 6
P Musialek @ i-MEET 2017
TCT 2016 Featured Research
PARADIGM
P. Musialek, A. Mazurek et al. EuroIntervention 2016;12:e658-70 (PARADIGM design and 30-day outcome data)
CGuard™ EPS human in situ OCT image courtesy Dr Joan Rigla, Perceptual Imaging Lab (University of Barcelona)
CGuard EPS
Musialek P et al. EuroIntervention 2016;12:e658-70
Wissgott C et al. J Endovasc Ther. 2017;24:130-137
P Musialek @ i-MEET 2017
Nitinol frame open-cell area ≈ 21 mm
MicroNet closed-cell area ≈ 0.3mm
carotid-dedicated design
√L A R G E S T
S M A L E S T
2
2 √ P Musialek @ i-MEET 2017
Per-Protocol DW-MRI cerebral imagingat B/L, 24-48h after CAS, and at 30 days
P Musialek @ i-MEET 2017
The Power of DW-MRI…
24h after RICA-CAS (TCAR +CGuard)
a SINGLE lesion
0.054 mL
M. Urbanczyk, RP. Banys – Dept. Radiology JP2 Hospital, Krakow
Complete Resolution on 90d follow-up
P Musialek @ i-MEET 2017
. Intra-procedural cerebralembolization is minimized
Post-procedural proceduralcerebral embolization is
eliminated
.
J. Schofer, P. Musialek, et al. JACC Interv 20152015;8:1229-1234
CGuard™ CASE V I D E N C E
√
…
2 0
1 6
E.W., woman, 58 y, TWO recent ( 20d and 5d )
R haemisphericminor strokes despite OMT !
P Musialek @ i-MEET 2017
T.W., man 69 yo
critical LICA stenosis
L haemisph stroke 5mo
LICA RICA
enough?
CGuard™ embolic prevention system
Mesh Prevention
of embolization
”works”
only from the moment
the mesh stent is implanted
Timing of neuro-embolic events after CAS
D. McCormick TCT 2012, modified
40-80%*
post-procedural strokeswith CAS (CAPTURE and
CREST data)
*
Procedural
Embolic ProtectionSystem
TransCarotid Artery Revascularization (TCAR)
Blood flow is reversed
Dynamic Flow Controller
& Integrated 200µ Filter
Hi / Low / Off
Blood flow is returned
to femoral vein
Working channel for
interventional devices
ENROUTE® Transcarotid
Stent System (57cm)
TransCarotid Artery Revascularization (TCAR)
Blood flow is reversed from
the common carotid artery
Dynamic Flow Controller
& Integrated 200µ Filter
Hi / Low / Off
Blood flow is returned
to femoral vein
Working channel for
interventional devices
ENROUTE® Transcarotid
Stent System (57cm)
TCAR = CLEAR ADVANTAGES1. avoiding arch2. avoiding access route-dependent embolization3. DYNAMIC flow reversal => ROBUST protection
√√√
TCAR=transcarotid CAS
efficient capture & removalof intra-procedural debris
.P Musialek @ i-MEET 2017
TCAR CGuard™
less embolic material during CASsustained anti-embolic after CAS
..Magnified image: C. Wissgott J Endovasc Ther. 2016
efficient capture & removalof intra-procedural debris
.P Musialek @ i-MEET 2017
Prospective evaluation of All-comer perRcutaneous cArotiDrevascularization In symptomatic and increased-stroke-riskasymptomatic carotid artery stenosis using the CGuard™™
MicroNet – covered embolic prevention stent system:
The PARADIGM –> EXTEND study
PARADIGM-101 P. Musialek, A. Mazurek, M. Trystula et al. EuroIntervention 2016
n=221 (31 May 2017)Consecutive Patient
CGuard CAS
P Musialek @ i-MEET 2017
2 0
1 6
P Musialek @ i-MEET 2017
T.W., man 69 yo
critical LICA stenosis
L haemisph stroke 5mo
LICA
(with haemorrh. transformation)
TW, man 69 yo 9 Dec 2015critical LICA stenosis
(stroke with haemorragic transformation 5mo before,now neuro-cleared for carotid revascularization )
P Musialek @ i-MEET 2017
TW, man 69 yo 9 Dec 2015critical LICA stenosis
(stroke with haemorragic transformation in Feb 2015,now neuro-cleared for carotid revascularization )
Hostile access
MoMa-FR intended
endoroutine accessabandoned
after 35 min attempts
P Musialek @ i-MEET 2017
TW, man 69 yo (Case #1) 12 Jan 2016critical LICA stenosis, post-stroke
First-in-Poland direct carotid access TCAR-FR CAS Under En Route (SilkRoad Medical) Flow Reversal
Surgical Team: M. Trystula, M. Kazubudzki, J. Krzywoń, A. Brzychczy; L. PinterEndo: P. Musialek & A. Mazurek
SurgicalAccess
P Musialek @ i-MEET 2017
TW, man 69 yo 12 Jan 2016critical LICA stenosis, post-stroke
lesion crossing, predil, CGuard stent implantation and postdilunder En Route (SilkRoad Medical) Flow Reversal
P Musialek @ i-MEET 2017
TW, man 69 yo 12 Jan 2016critical LICA stenosis, post-stroke
First-in-Poland direct carotid access CAS underEn Route (SilkRoad Medical) Flow Reversal
CGuard 7.0 x 30mm full endovascular reconstruction
P Musialek @ i-MEET 2017
TW, man 69 yo 12 Jan 2016critical LICA stenosis, post-stroke
First-in-Poland direct carotid access CAS underEn Route (SilkRoad Medical) Flow Reversal
CGuard 7.0x30mm full endovascular reconstruction
P Musialek @ i-MEET 2017
TW, man 69 yo 12 Jan 2016critical LICA stenosis, post-stroke
First-in-Poland direct carotid access CAS under En Route(SilkRoad Medical) Flow Reversal + CGuard™ MicroNet Stent
Z E R O new lesions
24h prior to CAS 48h after CAS
Brain Imaging: M. Urbanczyk, RP. Banys, Dept. Radiology, JP2 Hospital, Krakow P Musialek @ i-MEET 2017
TW, man 69 yo 12 Jan 2016critical LICA stenosis, post-stroke
24h prior to CAS 48h after CAS
Z E R O new lesions
Brain Imaging: M. Urbanczyk, RP. Banys, Dept. Radiology, JP2 Hospital, Krakow
First-in-Poland direct carotid access CAS under En Route(SilkRoad Medical) Flow Reversal + CGuard™ MicroNet Stent
P Musialek @ i-MEET 2017
TW, 69 y, h/o L haemispheric stroke with haemorragic transformation
Images: M. Urbanczyk & RP. Banys, Dept. of Radiology, John Paul II Hospital, Krakow
TTPTime-To-Peak
Flow
redis prolongued
yellowshows fast
Profound improvement of L hemiphericviable tissue perfusion
24h prior to CAS 48h after CAS
TCAR plus CGuard (Krakow, TCAR consecutive Case #1)
P Musialek @ i-MEET 2017
TTPTime-To-Peak
Flow
redis prolongued
yellowshows fast
Profound improvement of L hemiphericviable tissue perfusion
Images: M. Urbanczyk & RP. Banys, Dept. of Radiology, John Paul II Hospital, Krakow
24h prior to CAS 48h after CAS
TW, 69 y, h/o L haemispheric stroke with haemorragic transformation
En Route plus CGuard
P Musialek @ i-MEET 2017
TTPTime-To-Peak
Flow
redis prolongued
yellowshows fast
Images: M. Urbanczyk & RP. Banys, Dept. of Radiology, John Paul II Hospital, Krakow
24h prior to CAS 48h after CAS
Profound improvement of L hemiphericviable tissue perfusion
TW, 69 y, h/o L haemispheric stroke with haemorragic transformation
En Route plus CGuard
P Musialek @ i-MEET 2017
MTTMean Transit
Time
yellowgreen
is prolongued
blueshows fast
Profound improvement of L hemiphericviable tissue perfusion
Images: M. Urbanczyk & RP. Banys, Dept. of Radiology, John Paul II Hospital, Krakow
24h prior to CAS 48h after CAS
TW, 69 y, h/o L haemispheric stroke with haemorragic transformation
En Route plus CGuard
P Musialek @ i-MEET 2017
MTTMean Transit
Time
yellowgreen
is prolongued
blueshows fast
Profound improvement of L hemiphericviable tissue perfusion
Images: M. Urbanczyk & RP. Banys, Dept. of Radiology, John Paul II Hospital, Krakow
24h prior to CAS 48h after CAS
TW, 69 y, h/o L haemispheric stroke with haemorragic transformation
En Route plus CGuard
P Musialek @ i-MEET 2017
MTTMean Transit
Time
yellowgreen
is prolongued
blueshows fast
Profound improvement of L hemiphericviable tissue perfusion
Images: M. Urbanczyk & RP. Banys, Dept. of Radiology, John Paul II Hospital, Krakow
24h prior to CAS 48h after CAS
TW, 69 y, h/o L haemispheric stroke with haemorragic transformation
En Route plus CGuard
P Musialek @ i-MEET 2017
WE, woman, 58 y, 2x recent R haemispheric (minor) stroke
TCAR plus CGuard™ (Krakow, TCAR consecutive Case #2)
RICA
P Musialek @ i-MEET 2017
En Route (SilkRoad Medical) Dynamic Flow Reversal
movie
WE, woman, 58 y, 2x recent R haemispheric (minor) stroke
TCAR plus CGuard™ (Krakow, TCAR consecutive Case #2)
P Musialek @ i-MEET 2017
lesion crossing, predil, CGuard stent implantation and postdilunder En Route (SilkRoad Medical) Flow Reversal
movie
WE, woman, 58 y, 2x recent R haemispheric (minor) stroke
TCAR plus CGuard™ (Krakow, TCAR consecutive Case #2)
P Musialek @ i-MEET 2017
lesion crossing, predil, CGuard stent implantation and postdilunder En Route (SilkRoad Medical) Flow Reversal
movie
Debriscaptured
in the A-V shuntfilter
in this procedure
WE, woman, 58 y, 2x recent R haemispheric (minor) stroke
TCAR plus CGuard™ (Krakow, TCAR consecutive Case #2)
P Musialek @ i-MEET 2017
lesion crossing, predil, CGuard stent implantation and postdilunder En Route (SilkRoad Medical) Flow Reversal
WE, woman, 58 y, 2x recent R haemispheric (minor) stroke
TCAR plus CGuard™ (Krakow, TCAR consecutive Case #2)
P Musialek @ i-MEET 2017
CGuard 7.0x30 mm full endovascular reconstruction
Final Result
plus NO new lesions on DW-MRI !
WE, woman, 58 y, 2x recent R haemispheric (minor) stroke
TCAR plus CGuard™ (Krakow, TCAR consecutive Case #2)
P Musialek @ i-MEET 2017
Z E R O new lesions
24h prior to CAS 48h after CAS
Brain Imaging: M. Urbanczyk, RP. Banys, Dept. Radiology, JP2 Hospital, Krakow
WE, woman, 58 y, 2x recent R haemispheric (minor) stroke
TCAR plus CGuard™ (Krakow, TCAR consecutive Case #2)
P Musialek @ i-MEET 2017
Z E R O new lesions
24h prior to CAS 48h after CAS
Brain Imaging: M. Urbanczyk, RP. Banys, Dept. Radiology, JP2 Hospital, Krakow
WE, woman, 58 y, 2x recent R haemispheric (minor) stroke
TCAR plus CGuard™ (Krakow, TCAR consecutive Case #2)
P Musialek @ i-MEET 2017
Z E R O new lesions
24h prior to CAS 48h after CAS
Brain Imaging: M. Urbanczyk, RP. Banys, Dept. Radiology, JP2 Hospital, Krakow
WE, woman, 58 y, 2x recent R haemispheric (minor) stroke
TCAR plus CGuard™ (Krakow, TCAR consecutive Case #2)
P Musialek @ i-MEET 2017
TTPTime-To-Peak
Flow
redis prolongued
yellowshows fast
Images: M. Urbanczyk & RP. Banys, Dept. of Radiology, John Paul II Hospital, Krakow
Profound improvement in R hemiphericperfusion
24h prior to CAS 48h after CAS
WE, woman, 58 y, 2x recent R haemispheric (minor) stroke
TCAR plus CGuard™ (Krakow, TCAR consecutive Case #2)
P Musialek @ i-MEET 2017
TTPTime-To-Peak
Flow
redis prolongued
yellowshows fast
Images: M. Urbanczyk & RP. Banys, Dept. of Radiology, John Paul II Hospital, Krakow
Profound improvement in R hemiphericperfusion
24h prior to CAS 48h after CAS
WE, woman, 58 y, 2x recent R haemispheric (minor) stroke
TCAR plus CGuard™ (Krakow, TCAR consecutive Case #2)
P Musialek @ i-MEET 2017
TTPTime-To-Peak
Flow
redis prolongued
yellowshows fast
Images: M. Urbanczyk & RP. Banys, Dept. of Radiology, John Paul II Hospital, Krakow
Profound improvement in R hemiphericperfusion
24h prior to CAS 48h after CAS
WE, woman, 58 y, 2x recent R haemispheric (minor) stroke
TCAR plus CGuard™ (Krakow, TCAR consecutive Case #2)
P Musialek @ i-MEET 2017
PARADIGM - ExtendTCAR Substudy
Symptomatic – 73%; LICA – 64% (RICA – 36%)
Contralateral occlusion – 27%
PSV 2.4 – 4.7 (median 3.4) m/s
EDV 0.5 – 1.9 (median 1.1) m/s
Diabetes – 36%
Known CAD – 54% (h/o PCI or CABG = 67% CAD)
h/o RadioTx – 9%
All (100%) subjects – ipsilateral ischemic lesions
.
on baseline MRI
.
.
.
.
.
.
.P Musialek @ i-MEET 2017
All TCAR & CGuard CAS study patients(ie, clinically ”asymptomatic” and clinically symptomatic)
had ipsilateral cerebral ischemic lesions on MRI prior to CAS
=> HIGH CEREBRAL RISK cohort !
Pt ZCKRK-PARADIGM TCAR + CGuard #5 (LICA 100%, target RICA 90%)
Pt AK KRK-PARADIGM TCAR + CGuard #3 RICA 78%, irregular lesion
< examples >
P Musialek @ i-MEET 2017
PARADIGM - ExtendTCAR Substudy
General anesthesia – 36%, regional/local – 64% 100% CGuard™ EPS 1 CGuard™ stent per lesion/artery
(sizes: 7.0x30, 7.0x40, 8.0x30, 8.0x40, 9.0x30mm)Direct stenting – 9%, predilated – 91%Postdil with Φ 4.5-6.0mm balloon up to 20atm to minimizeresidual stenosis consistent with the PARADIGM algorithm*Flow reversal time 6min 20s – 11min 30s (median 7min 50s)
Duplex at 30 days: PSV 0.36-1.02 m/s (median 0.6)EDV 0.15m/s (median 0.15m/s)
ECA patency – 100%
.Procedural data:
.
..
..
.
* P. Musialek, A. Mazurek, M. Trystula et al. EuroIntervention 2016 P Musialek @ i-MEET 2017
PARADIGM - ExtendTCAR Substudy
MRI Cerebral Imaging (incl. DW-MRI with ADC)3 time points: ≤24h before CAS
≤48h after CAS
@ 90 ± 10 days after CASSlice thickness 5mm636 slices total, median number per patient/time-point – 19
2 independent radiologists, per-agreement evaluationMedis QBrain 1.1
100% clinical, neurologic, and MRI follow-up
No death, no stroke, no MI up to 90 days
.MRI Protocol & Analysis:
.
.
.
.
.
P Musialek @ i-MEET 2017
Patient BK KRK-PARADIGM TCAR + CGuard #11(S, cresc TIAs, high embolism risk)
TCAR + CGuard: The ONLY Post–proceduralCerebral Lesions (n=2 pts)
(this and next slide)
24h prior to RICA-CAS 24h after RICA-CAS 90 days after RICA-CAS
A SINGLE lesion 0.054 mL TOTAL resolutionNO new lesions
P Musialek @ i-MEET 2017
Patient PW (S) KRK-PARADIGM TCAR + CGuard #4
24h prior to LICA-CAS
”CAS-L” No 1
”CAS-L” No 2
”CAS-L” No 3
24h after LICA-CAS 90 days afer LICA-CAS
TCAR + CGuard For Symptomatic and High-Embolism Risk ”Asymptomatic” Carotid Stenosis
*High-risk plaque features plus MRI evidence of ipsilateral ischemic lesionsin ALL study subjects
Uncomplicated procedure
No neuro complications by discharge and 90 days
Nearly eliminated peri-procedural embolism (MRI)
Totally eliminated post-procedural embolismduring stent healing and by 90 days (MRI)
.
.
.
.
*
- V. low incidence (!)- V. low number (!)- V. low volume (!)
P Musialek @ i-MEET 2017
TCAR CGuard™
less embolic material during CASsustained anti-embolic after CAS
efficient capture & removalof intra-procedural debris
. ..Magnified image: C. Wissgott J Endovasc Ther. 2016
c o m p l e m e n t a r y.
P Musialek @ i-MEET 2017
TCAR CGuard™
less embolic material during CASsustained anti-embolic after CAS
efficient capture & removalof intra-procedural debris
. ..Magnified image: C. Wissgott J Endovasc Ther. 2016
c o m p l e m e n t a r yextremely efficient together.
.
P Musialek @ i-MEET 2017
TCAR CGuard™
less embolic material during CASsustained anti-embolic after CAS
efficient capture & removalof intra-procedural debris
. ..Magnified image: C. Wissgott J Endovasc Ther. 2016
c o m p l e m e n t a r yextremely efficient together
each ’helps’ differently( and at different stage ! )
..
.
P Musialek @ i-MEET 2017
The Problem of Conventional Carotid Stents
Image courtesy Joan Rigla, MD PhD; Perceptual Imaging Lab, Univerity of Barcelona
Human carotid artery treated using a conventional stent; OCT
P Musialek @ i-MEET 2017
TCT 2016 Featured ResearchCGuard OCT Image - human, in situ
Courtesy Dr Joan Rigla, MD PhDPerceptual Imaging Lab, Univerity of Barcelona CGuard™ EPS
P Musialek @ i-MEET 2017
13 March 2017; 68y man, Leriche aortaminor L haemisph stroke 5 days before, current TIA
whatwould YOU
do ?
…if no TCAR available
P Musialek @ i-MEET 2017
13 March 2017; 68y man, Leriche aortaminor L haemisph stroke 5 days before, current TIA
P. Musialek, M. Trystula P Musialek @ i-MEET 2017
13 March 2017; 68y man, Leriche aortaminor L haemisph stroke 5 days before, current TIA
P. Musialek, M. Trystula
Local anaesthesia Trans-carotid MoMa with Flow Reversal + CGuard
P Musialek @ i-MEET 2017
13 March 2017; 68y man, Leriche aortaminor L haemisph stroke 5 days before, current TIA
P. Musialek, M. Trystula
Trans-carotid MoMa with Flow Reversal + CGuard
P Musialek @ i-MEET 2017
CGuard Full Carotid Bifurcation Reconstruction, Pt discharged home 14.03.2017
P. Musialek, M. Trystula
Self-tapering with the CGuard
SmartFit technology
13 March 2017; 68y man, Leriche aortaminor L haemisph stroke 5 days before, current TIA
P Musialek @ i-MEET 2017
TCAR CGuard™+
P Musialek @ i-MEET 2017
L i m i t a t i o n sare very rare
anatomiclimitations
to TCAR(access)
limitationsto (any)
stent
TCAR
P Musialek @ i-MEET 2017
• >5cm = Working distance from clavicle to bifurcation– Distal tip of ENROUTE Arterial Sheath– Proximal edge of ENROUTE Transcarotid
Stent
• >6mm = CCA reference diameter
• CCA free of significant disease for safe sheath insertion – Avoid scar tissue from previous CEA
(if applicable)
Patient head and neck in position to be used during surgery
NOT for TCAR, NOT for CGuard
P Musialek @ i-MEET 2017
Man, 48y, minor stroke 4 days
thr
thr
CEAuncomplicated
NOT for TCAR, NOT for CGuard
P Musialek @ i-MEET 2017
Man, 63y, TIAs
CEA
short neck
low CCA division(not enough CCA for
TCAR sheath)
CCA disease
rock of calcium
.
.
.
.
TCAR CGuard™
less embolic material during CASsustained anti-embolic after CAS
..Magnified image: C. Wissgott J Endovasc Ther. 2016
efficient capture & removalof intra-procedural debris
.
+
P Musialek @ i-MEET 2017
TCAR + CGuard: Study Team
M. Trystula Vascular SurgeryA. Mazurek CardiologyA. Borratynska NeurologyM. Urbanczyk RadiologyP. Banys RadiologyR. Musial AnesthesiologyI. Leal Vascular SurgeryL. Pinter Vascular SurgeryA. Lesniak-Sobelga Duplex ImagingK. Bederski Thoracic SurgeryM. Kazibudzki Vascular SurgeryA. Brzychczy Vascular SurgeryM. Brozda Duplex ImagingM. Misztal Interv. AngiologyP. Podolec CardiologyP. Musialek Angiology & Cardiology
Investigator-Initiated, Non-Industry Funded, Academic Study
Jagiellonian University Medical College& John Paul II Hospital, Krakow, Poland
Another ( Rare but Important ) Problem of Conventional Carotid Stents:
Stent Design Allows Atherosclerotic Plaque In-Growth
Pt MK RICA
Precise 5.0x30mm (2005)
2014-2016 ”increasing restenosis”P Musialek @ i-MEET 2017
Another ( Rare but Important ) Problem of Conventional Carotid Stents:
Stent Design Allows Atherosclerotic Plaque In-Growth
Pt MK RICA
Precise 5.0x30mm (2005)
2014-2016 ”increasing restenosis”P Musialek @ i-MEET 2017
Atherosclerotic Plaque Growth Into The Open-Cell Stent Lumen
Treated with Neroprotected PTA Under IVUS – and CGuard™
PTA No flow
(movie)
Aspiration ’Half-open’Filter
RemovalP Musialek @ i-MEET 2017