Will mesh-covered stents help reduce stroke associated with carotid stent angioplasty?

Carotid stent angioplasty (CAS) has been shown to protect patient from future stroke long-term efficacy similar to carotid endarterectomy (CEA). The risk of minor stroke in the perioperative period is higher than with CEA and not related to cerebral protection during the CAS procedure since a significant portion of the neurologic events occur between 1 and 30 days following stent deployment. This observation suggests mechanisms integral to the stent itself may be pertinent such as plaque embolization thru the stent struts may occur. It appears that this embolic risk can be reduced by use of specific carotid stent designs that include a mesh covering to minimize the open struts areas and thus embolization through the carotid stent. Improvements in stent design that eliminate post-procedural debris embolization will expand the application of CAS for severe internal carotid artery atherosclerotic stenosis.