Comparison of short-term outcomes after carotid artery stenting according to different stent designs

Abstract

IntroductionIn the developed countries, stroke is the third most common cause of death. There are many data indicating that stents reduce the risk of embolism but there are few publications assessing whether different stent designs can influence the periprocedural complications.AimTo determine the effects of open- and closed-cell stent designs on 1-month results of carotid artery stenting (CAS).Material and methodsThe study group consisted of 290 consecutive patients (216 men and 74 women, mean age 66.6 ±8.7 years). Neuroprotection with a distal protection device was used in all cases. The patients were divided into two groups: the open-cell stent group (n = 144) and the closed-cell stent group (n = 138). Major adverse cardiac and cerebrovascular events (MACCE) described as myocardial infarction, stroke and death within 1 month were recorded and analysed subsequently. Periprocedural hypotension and transient cerebral ischaemia at 1 month after the CAS procedure were also assessed.ResultsWe treated 290 carotid stenoses and stents were implanted in all patients. Fifteen patients (5.5%) were treated by staged CAS due to bilateral carotid artery disease. The technical success rate was 97.2%. There was no difference in the MACCE and transient cerebral ischaemia rate at 1 month between the two groups (p = 0.44 and p = 0.94, respectively). The incidence of ischaemic stroke was lower in the closed-cell stent group (2.77% vs. 0%; p = 0.04). The periprocedural rate of hypotension was higher in the closed-cell stent group (2.1% vs. 7.2%; p = 0.04).ConclusionsClosed-cell stents are associated with a low rate of ischaemic stroke. We think that closed-cell stents may be preferred in patients at high risk of embolism.

Cerebral Protection in Carotid Angioplasty – Is There a Need? Advantages and Disadvantages of Each Type of Protection Device

“…Although the filter is the central focus of discussion in most articles cited here for preventing embolization during CAS, the stent is the material used to effectively treat plaque to prevent embolic ischemic conditions in the long run. Our data do not show important significant differences between the brands of stent tested and the brands of protection filters used, as in Kastrup et al [35] and Palombo et al [75] [106]. Moreover, Hart et al [45], studying 701 CASs, stated that closed-cell stents and eccentric filters had lower rates of TIA/ICVA/death combination 30 days after the procedure in symptomatic patients and patients with echolucent plaques in ultrasound.…”

Effect of Open- vs Closed-Cell Stent Design on Periprocedural Outcomes and Restenosis After Carotid Artery Stenting: A Systematic Review and Comprehensive Meta-analysis

“…The majority (n=31) of the included studies were observational cohort analyses 8,14–43 and 2 were RCTs. 44,45 In total, 20,291 patients (mean age 71.3±3.0 years; 74.6% men) were included in this meta-analysis; 11,259 in the open-cell stent group and 9032 in the closed-cell stent group.…”

Meta-analysis of the Effect of Stent Design on 30-Day Outcome After Carotid Artery Stenting

“…The initial search identified 10 studies that compared the effects of stent cell design on CAS outcome 9–18 ; one study 18 was excluded because the cohort was also included in a later report.…”