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Contemporary carotid artery stenting practices and peri-procedural outcomes in different European countries: ROADSAVER study multicentric insights Muller-Hulsbeck, Stefan Vajda, Zsolt ruzsa, zoltan Beelen, Roel Gjoreski, Aleksandar Tomasello, Alejandro Odrowaz-Pieniazek, Piotr Institut Català de la Salut [Müller Hülsbeck S] Department of Diagnostic and Interventional Radiology and Neuroradiology, DIAKO Hospital GmbH, Academic Teaching Hospital ChristianAlbrechtsUniversity Kiel–Faculty of Medicine, Deaconess Hospital Flensburg, Flensburg, Germany. [Vajda Z] Neurovascular Unit, Moritz Kaposi Teaching Hospital, Kaposvár, Hungary. Department of Radiology, Fejér County Szent György University Teaching Hospital, Székesfehérvár, Hungary. [Odrowąż Pieniążek P] Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, Krakow, Poland. Department of Vascular Surgery Division on Endovascular Therapy, John Paul II Hospital, Krakow, Poland. [Ruzsa Z] BácsKiskun County Hospital, Teaching Hospital of the SzentGyörgyi Albert Medical University, Kecskemét, Hungary. Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary. [Beelen R] Department of Vascular and Thoracic Surgery, O.L.V. Aalst, Aalst, Belgium. [Gjoreski A] Department for Diagnostic and Interventional Radiology, Clinical Hospital “Acibadem Sistina”, Skopje, North Macedonia. [Tomasello Weitz A] Secció de Neuroradiologia Intervencionista, Servei de Radiodiagnòstic, Vall d’Hebron Hospital Universitari, Barcelona, Spain Vall d'Hebron Barcelona Hospital Campus Pròtesis de Stent Artèries caròtides Cirurgia Vasos sanguinis - Malalties - Cirurgia Avaluació de resultats (Assistència sanitària) DISEASES::Cardiovascular Diseases::Vascular Diseases::Arterial Occlusive Diseases::Cardiovascular Diseases::Vascular Diseases::Carotid Stenosis Other subheadings::Other subheadings::Other subheadings::/surgery ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Equipment and Supplies::Prostheses and Implants::Stents ANATOMY::Cardiovascular System::Blood Vessels::Arteries::Carotid Arteries Other subheadings::Other subheadings::Other subheadings::/surgery ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Prognosis::Treatment Outcome ENFERMEDADES::enfermedades cardiovasculares::enfermedades vasculares::arteriopatías oclusivas::enfermedades cardiovasculares::enfermedades vasculares::estenosis carotídea Otros calificadores::Otros calificadores::Otros calificadores::/cirugía TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::equipos y suministros::prótesis e implantes::stents ANATOMÍA::sistema cardiovascular::vasos sanguíneos::arterias::arterias carótidas Otros calificadores::Otros calificadores::Otros calificadores::/cirugía TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::pronóstico::resultado del tratamiento Carotid artery; Geographical variation; Stents Arteria carótida; Variación geográfica; Stents Artèria caròtida; Variació geogràfica; Stents Background Regional variations in patient selection and procedural techniques for carotid artery stenting have been well documented. However, their impact on procedural outcomes, especially with the use of dual-layer micromesh stents, is not fully understood. Methods This prospective, multi-center observational study included 1965 patients with asymptomatic or symptomatic carotid artery stenosis treated with the Roadsaver dual-layer micromesh stent. The primary outcome measure was the 30-day rate of major adverse events, defined as any death or stroke occurring within 30 days post-procedure. This sub-analysis compared patient characteristics and procedural techniques across 13 participating countries and investigated differences in outcomes via logistic regression modelling. Results Patient demographics, comorbidities, and symptom presentation varied widely among countries. Similarly, the frequency of use of duplex ultrasound and diffusion-weighted magnetic resonance imaging at baseline and 30-day follow-up differed. Procedural approaches also varied, with differences in femoral access site selection (18.2% to 100.0%), use of embolic protection devices (0.0% to 100.0%), pre-dilatation (4.3% to 46.7%) and post-dilatation (66.7% to 100.0%). Although 30-day major adverse event rates differed across the compared countries, after adjusting for post-dilatation balloon pressure (categorized as no post-dilatation vs. ≤ 11atm vs. > 11atm), and the number of enrolled patients per study site, the difference became statistically non-significant. Conclusion Our study reveals variability in patient selection, procedural carotid stenting practices and clinical outcomes across European countries. The differences in 30-day any death or stroke rates between countries may be attributed to differing post-dilatation practices and the number of enrolled patients per study site. Level of evidence Level 3, observational study. The study was funded by Terumo Europe. 2025-05-29T06:39:45Z 2025-05-29T06:39:45Z 2025-04-12 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Müller-Hülsbeck S, Vajda Z, Odrowąż-Pieniążek P, Ruzsa Z, Beelen R, Gjoreski A, et al. Contemporary carotid artery stenting practices and peri-procedural outcomes in different European countries: ROADSAVER study multicentric insights. CVIR Endovasc. 2025 Apr 12;8:29. 2520-8934 http://hdl.handle.net/11351/13166 10.1186/s42155-025-00528-z 40220262 001466010800001 http://hdl.handle.net/11351/13166 eng CVIR Endovascular;8 https://doi.org/10.1186/s42155-025-00528-z Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess application/pdf Springer Nature Scientia