The Efficacy of Dual-layer Stent Compared to Single-layer Stent in Carotid Revascularization: A Systematic Review and Meta-analysis

IF 1.4 4区医学 Q3 PERIPHERAL VASCULAR DISEASE

Annals of vascular surgery Pub Date : 2025-03-19 DOI:10.1016/j.avsg.2025.02.031

Jianfeng Gao, Yida Cao, Yaoguo Yang, Shuo Wang, Huanqin Zheng, Zhong Chen

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Abstract

Background

Prior studies have demonstrated the dual-layer stent (DLS) was associated with encouraging results in carotid revascularization. This meta-analysis aimed to study the comparative efficacy between DLS and single-layer stent (SLS).

Methods

The studies were retrieved from PubMed, Embase, and Scopus up to June 2023. The methodological evaluation was performed using the corresponding scale. Pooled analysis was conducted using R Studio to calculate the effects, including odds ratio (OR) and mean difference (MD). Heterogeneity among results was assessed using the I² statistic. Sensitivity analysis and subanalysis were also performed.

Results

In this meta-analysis, nine articles comprising 1,127 patients who underwent carotid stenting (606 with DLS) were studied. No significant difference between DLS and SLS was found in stroke (at 30 days DLS: 4/555 vs. SLS: 11/496; OR 0.38, 95% confidence interval [CI] 0.14–1.03; at 12 months DLS: 1/249 vs. SLS: 4/152; OR 0.21, 95% CI 0.03–1.36), death (at 30 days DLS: 3/526 vs. SLS: 0/467; OR 0.80, 95% CI 0.20–3.11; at 12 months DLS: 5/249 vs. SLS: 3/152; OR 1.12, 95% CI 0.25–5.03), stroke/death (at 30 days DLS: 6/526 vs. SLS: 11/467; OR 0.43, 95% CI 0.16–1.17; at 12 months DLS: 6/249 vs. SLS: 7/152; OR 0.52, 95% CI 0.17–1.61), new lesions (DLS: 56/202 vs. SLS: 96/254; OR 0.62, 95% CI 0.28–1.40), lesion count (MD = −0.24, 95% CI -0.82–0.34), lesion diameter (MD = −0.03, 95% CI -1.21–1.15), in-stent restenosis (ISR; DLS: 5/204 vs. SLS: 8/190; OR 0.61, 95% CI 0.21–0.74) and acute thrombosis (DLS: 4/146 vs. SLS: 1/122; OR 2.03, 95% CI 0.31–13.26). Subgroup analysis indicated that CGuard and Casper had shown similar efficacy in preventing stroke, death, and new brain lesions.

Conclusion

DLS has shown comparable prognoses to the first-generation stent concerning stroke, stroke/death, new magnetic resonance imaging lesion incidence, lesion count, lesion diameter, ISR and acute thrombosis. Further randomized trials are warranted to demonstrate whether patients with high-risk carotid plaques can benefit significantly from DLS.

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来源期刊

Annals of vascular surgery 医学-外科

CiteScore

3.00

自引率

13.30%

发文量

603

审稿时长

50 days

期刊介绍： Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal: Clinical Research (reports of clinical series, new drug or medical device trials) Basic Science Research (new investigations, experimental work) Case Reports (reports on a limited series of patients) General Reviews (scholarly review of the existing literature on a relevant topic) Developments in Endovascular and Endoscopic Surgery Selected Techniques (technical maneuvers) Historical Notes (interesting vignettes from the early days of vascular surgery) Editorials/Correspondence