Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.202501191
Jornal Vascular Brasileiro
Therapeutic Challenge

Angioplastia de carótida com implante de stent recoberto de dupla malha em paciente de anatomia complexa

Carotid artery stenting with dual-layer stent implantation in a patient with complex anatomy

Gislaine dos Santos Rodrigues Vieira; Ana Luiza Feitosa Leite de Souza; Crislayne dos Santos Rodrigues; João da Silva Junior; Nelson Ogliari Rezende; William Wakasugui; Helen Caroline Magalhães Costa; Vinicius Tadeu Ramos da Silva Grillo

Downloads: 0
Views: 5

Resumo

A aterosclerose carotídea associada à estenose hemodinamicamente significativa é uma condição grave que requer diagnóstico preciso e tratamento eficaz para prevenir eventos cardiovasculares, como o acidente vascular cerebral. As estratégias terapêuticas, incluindo a angioplastia carotídea e a endarterectomia carotídea, têm evoluído continuamente, proporcionando opções mais seguras e minimamente invasivas. O presente relato descreve o caso de um paciente do sexo masculino, portador de dislipidemia, hipertensão e coronariopatia, com diagnóstico de suboclusão da artéria carótida interna esquerda secundária a placa com características de instabilidade. Considerando o elevado potencial embólico da lesão e o risco de embolização associado ao tratamento endovascular convencional, optou-se pela utilização de um stent CGuardTM recoberto por dupla malha micropermeável e sistema de proteção embólica distal. Apesar das dificuldades técnicas relacionadas às variações anatômicas do paciente, o procedimento foi realizado com sucesso, e a evolução clínica foi favorável, demonstrando a aplicabilidade dessa tecnologia em cenários anatômicos complexos.

Palavras-chave

estenose carotídea; angioplastia transluminal percutânea; variação anatômica

Abstract

Carotid atherosclerotic disease associated with hemodynamically significant stenosis is a serious condition that requires accurate diagnosis and effective treatment to prevent cardiovascular events such as stroke. Treatment strategies, including carotid angioplasty and carotid endarterectomy, have evolved considerably, providing safer and less invasive therapeutic options. This report describes the case of a male patient with dyslipidemia, hypertension, and coronary artery disease who presented with near-occlusion of the left internal carotid artery caused by a plaque with features of instability. Given the lesion’s high embolic potential and the risk of embolization associated with conventional endovascular treatment, a dual-layer micromesh-covered CGuardTM stent was used in conjunction with a distal embolic protection device. Despite the technical challenges related to the patient’s vascular anatomy, the procedure was successfully completed, and the patient experienced a favorable clinical outcome, demonstrating the applicability of this technology in anatomically complex scenarios.

Keywords

carotid stenosis; percutaneous transluminal angioplasty; anatomical variation

References

1 Naylor AR, Ricco JB, de Borst GJ, et al. Editor’s choice – management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(1):3-81. https://doi.org/10.1016/j.ejvs.2017.06.021. PMid:28851594.

2 von Buettner Ristow A, Massière B, Vieira Meirelles G, et al. Diretrizes da Sociedade Brasileira de Angiologia e Cirurgia Vascular para o tratamento da doença cerebrovascular extracraniana. J Vasc Bras. 2024;23:e20230094.

3 Bonati LH, Kakkos S, Berkefeld J, et al. European Stroke Organisation guideline on endarterectomy and stenting for carotid artery stenosis. Eur Stroke J. 2021;6(2):I-XLVII. https://doi.org/10.1177/23969873211012121. PMid:34414302.

4 Pini R, Faggioli G, Paraskevas KI, et al. Carotid artery stenting with double-layer stent: a systematic review and meta-analysis. J Endovasc Ther. 2024;31(3):339-49. https://doi.org/10.1177/15266028221126940. PMid:36214459.

5 Abdullayev N, Maus V, Mpotsaris A, et al. Comparative analysis of CGUARD embolic prevention stent with Casper-RX and Wallstent for the treatment of carotid artery stenosis. J Clin Neurosci. 2020;75:117-21. https://doi.org/10.1016/j.jocn.2020.03.008. PMid:32173154.

6 Wissgott C, Schmidt W, Brandt-Wunderlich C, Behrens P, Andresen R. Clinical results and mechanical properties of the carotid CGUARD double-layered embolic prevention stent. J Endovasc Ther. 2017;24(1):130-7. https://doi.org/10.1177/1526602816671134. PMid:27733689.

7 Sirignano P, Stabile E, Mansour W, et al. 1-year results from a prospective experience on CAS using the CGuard stent system. JACC Cardiovasc Interv. 2021;14(17):1917-23. https://doi.org/10.1016/j.jcin.2021.05.045. PMid:34391704.

8 Tigkiropoulos K, Nikas S, Manolis AP, et al. One-year outcomes of CGuard double mesh stent in carotid artery disease: a systematic review and meta-analysis. Medicina (Kaunas). 2024;60(2):286. https://doi.org/10.3390/medicina60020286. PMid:38399573.

9 Conte Neto N, Gonçalves TT, Louis C, Ikikame J, Góes AMO Jr. Acesso cirúrgico ao segmento cervical distal da artéria carótida interna e à bifurcação carotídea alta – revisão integrativa da literatura e proposta de protocolo. J Vasc Bras. 2022;21:e20210193. https://doi.org/10.1590/1677-5449.202101931.

10 Zidan M, Gronemann C, Lehnen NC, et al. Stenting with dual-layer CGuard stent in acute sub-occlusive carotid artery stenosis and in tandem occlusions: a monocentric study. Neuroradiology. 2024;66(9):1635-44. https://doi.org/10.1007/s00234-024-03397-w. PMid:38844697.

11 Piske RL, Ferreira MS, Campos CMS, et al. Técnica de proteção cerebral na angioplastia e “stent” de carótida: um procedimento eficaz contra embolia. Arq Neuropsiquiatr. 2003;61(2A):296-302. https://doi.org/10.1590/S0004-282X2003000200028. PMid:12806517.

12 Mellucci Filho PL, Bertanha M, Jaldin RG, Yoshida WB, Sobreira ML. Pós-processamento da mediana de escala de cinza (GSM), posterização e remapeamento de cores para ultrassonografia de carótidas. J Vasc Bras. 2023;22:e20220081. https://doi.org/10.1590/1677-5449.202200811.

13 Olveira GP, Guillaumon AT, Benvindo SC, et al. A comparative analysis of transcranial Doppler parameters acquired during carotid stenting and semi-eversion carotid endarterectomy. J Vasc Bras. 2016;15(3):197-204. https://doi.org/10.1590/1677-5449.003316. PMid:29930590.

14 Wodarg F, Turner EL, Dobson J, et al. Influence of stent design and use of protection devices on outcome of carotid artery stenting: a pooled analysis of individual patient data. J Neurointerv Surg. 2018;10(12):1149-54. https://doi.org/10.1136/neurintsurg-2017-013622. PMid:29674483.

15 Klail T, Kurmann C, Kaesmacher J, et al. Safety and efficacy of carotid artery stenting with the CGuard double-layer stent in acute ischemic stroke. Clin Neuroradiol. 2023;33(1):237-44. https://doi.org/10.1007/s00062-022-01209-3. PMid:36070140.

16 Schofer J, Musiałek P, Bijuklic K, et al. A prospective, multicenter study of a novel mesh-covered carotid stent. JACC Cardiovasc Interv. 2015;8(9):1229-34. https://doi.org/10.1016/j.jcin.2015.04.016. PMid:26292586.
 


Submitted date:
08/13/2025

Accepted date:
06/09/2026

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
6a8de7d4a95395558903c4d6 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections