{
  "abstract": "Introduction The Neuroguard 3-in-1 system is a nitinol carotid stent incorporating an integrated embolic protection filter and post-dilation balloon for carotid artery stenosis treatment. This study evaluates its safety and efficacy in a real-world, post-marketing clinical setting.Methods This retrospective multicenter study included patients with carotid artery stenosis who underwent Neuroguard stenting across nine centers between November 2024 and December 2025. Patients with recent disabling stroke were excluded. The primary outcomes were symptomatic stroke, myocardial infarction, early neurological deterioration (END), defined as an increase of ≥4 points in NIHSS within 24 hours post-procedure, and 30-day periprocedural or non-periprocedural mortality. Secondary outcomes included intraprocedural distal embolization, and intracranial hemorrhage.Results A total of 116 patients were included, with a median clinical follow-up of 90 days (IQR, 90-93). 38 patients (32.8%) were female, and the mean age was 71.9±10.6 years. At presentation, 84 patients (72.4%) were symptomatic, with a median symptom duration of 3 days, and a median preprocedural NIHSS score of 1 (IQR, 0-4). The mean internal carotid artery stenosis, assessed by NASCET criteria, was 74.1±17.4%. Plaque length was <10 mm in 44 cases (37.9%), 10-15 mm in 41 cases (35.3%), and >15 mm in 31 cases (26.7%). Intervention details are summarized in figure 1. Technical success was achieved in 115 patients (99.1%); one failure was due to severe extracranial ICA tortuosity, which prevented proper stent positioning. No distal embolization events were observed. Periprocedural complications included symptomatic ischemic stroke in 2 patients (1.7%) and symptomatic intracranial hemorrhage in 1 (0.9%); no myocardial infarction occurred. END was observed in 2 patients (1.7%). The 30-day mortality rate was 1.7% (n=2), both due to sepsis unrelated to the procedure. Three additional non-periprocedural deaths (3.5%) occurred, including one following repeat stenting complicated by ventricular fibrillation. Asymptomatic intracranial hemorrhage occurred in 2 patients (1.8%) (ECASS HI1 and PH2). Imaging follow-up was available in 62 patients at a median of 42 days, demonstrating patent stents in 62.9%, 0-50% restenosis in 21.0%, 50-70% restenosis in 11.3%, and occlusion in 3.2%. At last follow-up, median mRS was 1 (IQR, 0-4) and NIHSS was 0 (IQR, 0-2).Conclusion In this multicenter post-marketing evaluation, the Neuroguard system demonstrated favorable 90-day safety and efficacy for carotid artery stenosis, with outcomes comparable to contemporary trials of symptomatic disease, including CREST. Further evaluation with larger cohorts and extended follow-up is necessary.Disclosures O. Shoraka: None. A. Peled: None. K. Richter: None. S. Miller: None. O. De Toledo: None. E. Hashmi: None. R. Rennert: None. C. Kilburg: None. K. Budohoski: None. G. Weiner: None. E. Yap: None. T. Bhalla: None.Abstract O-019 Table 1Summary of procedural details for neuroguard stenting in this cohort",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, University of Utah, Salt Lake City, UT"
      ],
      "name": "O Shoraka"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Utah, Salt Lake City, UT"
      ],
      "name": "A Peled"
    },
    {
      "affiliations": [
        "Neurosurgery, Geisinger, Wilkes-Barre, PA"
      ],
      "name": "K Richter"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Rochester Medical Center, Rochester, NY"
      ],
      "name": "P Valdes Barrera"
    },
    {
      "affiliations": [
        "JFK University Medical Center - Hackensack Meridian Health, Edison, NJ"
      ],
      "name": "T Snyder"
    },
    {
      "affiliations": [
        "Geisinger Health System, wilkes barre, PA"
      ],
      "name": "A Aljuboori"
    },
    {
      "affiliations": [
        "Neurology, Valley Baptist Medical Center, Harlingen, TX"
      ],
      "name": "S Miller"
    },
    {
      "affiliations": [
        "Neurosurgery, Baptist Medical Center, Jacksonville, FL"
      ],
      "name": "O De Toledo"
    },
    {
      "affiliations": [
        "Neurology, Cooper University Health, Camden, NJ"
      ],
      "name": "J Khalife"
    },
    {
      "affiliations": [
        "Neurosurgery, Cooper University, Cherry Hill, NJ"
      ],
      "name": "E Hashmi"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Utah, Salt Lake City, UT"
      ],
      "name": "R Rennert"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Utah, Salt Lake City, UT"
      ],
      "name": "C Kilburg"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Utah, Salt Lake City, UT"
      ],
      "name": "K Budohoski"
    },
    {
      "affiliations": [
        "Neurosurgery, Geisinger, Wilkes-Barre, PA"
      ],
      "name": "G Weiner"
    },
    {
      "affiliations": [
        "Geisinger Health System, Wilkes-Barre, PA"
      ],
      "name": "C Schirmer"
    },
    {
      "affiliations": [
        "ponte vedra, FL"
      ],
      "name": "R Hanel"
    },
    {
      "affiliations": [
        "Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, FL"
      ],
      "name": "SF Gutierrez-Aguirre"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Endeavor Health, Evanston, IL"
      ],
      "name": "WJ Ares"
    },
    {
      "affiliations": [
        "Neurosurgery, University of North Carolina, Chapel Hill, NC"
      ],
      "name": "E Yap"
    },
    {
      "affiliations": [
        "Neurology, UTSCHSA Valley Baptist, Harlingen, TX"
      ],
      "name": "A Hassan"
    },
    {
      "affiliations": [
        "Neurological Surgery, Cooper University Hospital, Camden, NJ"
      ],
      "name": "D Tonetti"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Rochester, Rochester, NY"
      ],
      "name": "M Bender"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Rochester, Rochester, NY"
      ],
      "name": "T Bhalla"
    },
    {
      "affiliations": [
        "Edison, NJ"
      ],
      "name": "B Jankowitz"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Rochester, Rochester, NY"
      ],
      "name": "R Grandhi"
    }
  ],
  "title": "O-019 Multicenter evaluation of the safety and efficacy of the neuroguard 3-in-1 system for carotid artery stenosis",
  "uid": "42494bdc-581e-5149-a057-324dc2bf3786"
}