{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T12:04:37Z","timestamp":1789646677967,"version":"4.0.0"},"reference-count":32,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2023,3,13]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Periprocedural lipid core plaque (LCP) has been detected in carotid arteries assessed by catheter-based near-infrared spectroscopy (NIRS). High LCP is associated with cerebral embolism after carotid artery stenting (CAS) using a first-generation stent. We aimed to evaluate whether dual-layered stents reduce embolic infarcts in patients with high LCP and change of lipid signal as assessed by NIRS during CAS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Participants comprised 210 consecutive patients undergoing CAS. The study was divided into two distinct periods, with first-generation closed-cell stents used in the earlier period and dual-layered stents used in the later period. NIRS was performed at baseline, after stent implantation, and after balloon post-dilatation to analyze maximal lipid core burden index at minimal luminal area (max-LCBI<jats:sub>MLA<\/jats:sub>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The ipsilateral cerebral embolism rate was significantly lower with dual-layered stents (9%) than with first-generation stents (33%, p&lt;0.001), particularly with highly lipidic lesions (12% vs 60%, p&lt;0.001). On multivariate logistic regression analysis, high LCP and first-generation stent usage were factors related to ipsilateral cerebral embolism (both p&lt;0.001; OR 8.28 (95% CI 3.49 to 19.64) and OR 8.07 (95% CI 2.33 to 27.93), respectively). Max-LCBI<jats:sub>MLA<\/jats:sub>decreased significantly after stenting in both groups (both p&lt;0.01) and max-LCBI<jats:sub>MLA<\/jats:sub>after balloon post-dilatation was significantly lower with dual-layered stents (22.4\u00b165.6) than with first-generation stents (124.2\u00b1208.2; p=0.006).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Dual-layered stents reduce embolic infarcts in patients with highly lipidic plaque lesions as assessed by NIRS who undergo CAS. Dual-layered stents significantly reduced NIRS-derived lipid signals after stenting.<\/jats:p><\/jats:sec>","DOI":"10.1136\/jnis-2023-020106","type":"journal-article","created":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T17:20:54Z","timestamp":1679419254000},"page":"67-72","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Dual-layered stents reduce cerebral embolism compared with first-generation stents during carotid stenting of high lipid core plaque 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