Does Carotid Stent Cell Design Matter?

Abstract

Background and Purpose-Carotid stent cell design has recently been suggested to be a determinant of periprocedural and early postprocedural neurologic complications. We investigated the impact of closed-versus open-cell stent design on neurologic adverse events and mortality after carotid artery stenting. Methods-We studied 1684 consecutive patients (1010 asymptomatic, 674 symptomatic) from 10 European centers who underwent carotid artery stenting with either closed-cell (nϭ859, 51%) or open-cell (nϭ825, 49%) design stents. Rates of transient ischemic attack, stroke, and death on the day of the procedure (acute events) and from day 1 to day 30 after the procedure (subacute events) were analyzed (95% CIs). Results-Combined transient ischemic attack, stroke, or death rates, and stroke or death rates within 30 days of treatment were 6.1% (95% CI, 5.0 to 7.2) and 3.1% (95% CI, 2.3 to 3.9) for the closed-cell design versus 4.1% (95% CI, 3.2 to 5.0) and 2.4% (95% CI, 1.7 to 3.1) for the open-cell design stents (Pϭ0.077, Pϭ0.38), respectively, without significant differences in asymptomatic and symptomatic patients. By propensity-score-adjusted multivariable analysis, the open-cell carotid stent design was not associated with a differential risk for combined acute and subacute neurologic complications compared with closed-cell stents (adjusted odds ratioϭ0.84, Pϭ0.53). When analyzed separately, the risk for acute events on the day of the procedure (adjusted odds ratioϭ0.83, Pϭ0.57) and the risk for subacute events at days 1 to 30 (adjusted odds ratioϭ1.61, Pϭ0.51) also were not significantly different between the groups. Conclusions-Current data do not support the superiority of a specific carotid stent cell design with respect to neurologic complications, stroke, and mortality risk.

Protection or Nonprotection in Carotid Stent Angioplasty

“…8 However, only few data are available as to whether different stent designs can influence the clinical outcome. 9,10 Stent designs can be categorized as open cell or closed cell. Open cell stents show a smaller surface covering than closed cell stents after deployment.…”

Discussion

“…In that registry, the difference between designs was primarily seen in symptomatic patients and much emphasis was made on the particularly protective benefit of closed-cell stents in terms of reduction postprocedure events. In the study reported by Schillinger, at al, 2 there was a nonsignificant trend towards fewer "subacute" events in patients who had CAS with closed-cell stents. The study may not have been adequately powered to demonstrate an effect.…”

Simultaneous Kissing Stenting: A Valuable Technique for Reconstructing the Stenotic Initial Segment of the Right Subclavian Artery

“…Either open-cell or closed-cell stents may be used indiscriminately in most carotid artery stenting procedures. No significant differences in the rates of major adverse events, including stroke-death, have been reported in recent study [11]. Though closed-cell stents are less flexible and may develop kinks and incomplete expansion, they potentially offer maximal scaffolding to the vessel wall, which makes them more suitable for lesions with vulnerable plaques or suspected high embolic potential [12].…”