Overcoming plaque prolapse: the dual-design advantage
Traditional carotid stenting often forces operators to choose between two structural limitations: closed-cell stents, which offer plaque protection but lack flexibility, and open-cell stents, which conform well to tortuous vessels but leave atherosclerotic plaque unconstrained. Adnan Siddiqui emphasized that this structural compromise is a critical flaw, given that two-thirds of post-procedural strokes are caused by delayed plaque prolapse through the stent tines.
The C-Guard® carotid stent resolves this challenge by using a unique hybrid platform:
- A nitinol open-cell skeleton, which preserves excellent vessel conformability, wall apposition, and anatomical adaptation.
- A 165 µm MicroNet ™ mesh to provide complete plaque coverage, preventing embolic debris from migrating downstream after the protection devices are removed.
Record-breaking clinical data and acute tandem stroke applications
One-year data from the C-GUARDIANS trial, which led to US regulatory approval, demonstrated an unprecedented 30-day death, stroke, and MI rate of just 0.95% (0.63% per protocol). This represents the lowest complication rate ever recorded in an adjudicated carotid stent trial, outperforming classic endarterectomy and TCAR data. Ipsilateral stroke at one year also represents a very low 1.95% rate (1.70% per protocol).Furthermore, its versatile delivery systems allow it to be deployed effectively via both transfemoral access and the TCAR approach to match different operator skill sets.
Beyond elective cases, Adnan Siddiqui highlighted the device's exceptional performance in acute tandem lesions, where an intracranial occlusion coexists with a ruptured, highly unstable proximal carotid plaque. Because the C-Guard® features a remarkably low metal surface area (6–7%), its dual antiplatelet requirements are less stringent than traditional dense mesh designs.
