Prevalence of Carotid Stent Fractures in a Single-Center Experience

Abstract

Stent fractures do occur in the carotid artery; however, they are rare and, in our experience, have no clinical sequelae. Radiological assessment should be incorporated into clinical and ultrasound surveillance protocols.

Prevalence and clinical significance of stent fracture and deformation following carotid artery stenting

“…Whether these stent changes were associated with restenosis or symptoms was not reported. 12 Our series, which is the largest to date, underscores the not insignificant incidence of stent fracture and/or deformation following carotid bifurcation stenting, approaching a combined rate of 50% at 4 years. The prevalence of stent fracture in our series was observed to be 4% and that of stent deformation to be 23%.…”

“…11 In contrast, Varcoe et al described a fracture rate of 2% in 51 carotid stents and noted no clinical sequelae. 12 Ling et al did not address stent deformation at all. However, Varcoe et al noted that 11% of carotid stents had developed an irregular "fish-scale" appearance that could be confused for fracture.…”

“…Two case series have noted fairly disparate rates of stent fracture following carotid artery stenting, varying between 2% and 29%. 11,12 Furthermore, these studies had different conclusions regarding the clinical impact of fractures with one observing a higher restenosis rate in fractured stents 11 and the other noting no clinical sequelae. 12 In addition to stent fracture, the potential for stent deformation without fracture also exists, and the incidence and clinical impact of stent deformation is also unknown.…”

A Case of Folding Deformation of PROTÉGÉ Stent during Carotid Artery Stenting with Distal Embolic Protection

“…6) Some accounts in the literature have reported that intraprocedural stent deformation or fracture had no direct influence on postprocedural incidence of cerebral infarction or re-treatment. [2][3][4] However, as cases of cerebral infarction induced by delayed folding deformation of PROTÉGÉ have also been reported and strict follow-up is necessary. 3) Since a folded stent protrudes into the vascular lumen, thrombus formation is more likely than in usual CAS and long-term intensive antiplatelet therapy is necessary.…”

“…A small number of reports have described stent deformation or fracture associated with placement, with a reported incidence of 1.9%-29.2%. 1,2) A case of folding deformation of PROTÉGÉ stent during CAS with distal filter protection is presented. Retrieval of the filter device was difficult due to the folding deformation.…”