Complications Specific to Closed and Open Cell Nitinol Stents in Carotid Artery Stenting

Purpose:To compare periprocedural complications and in-stent restenosis rates associated with open- vs closed-cell stent designs used in carotid artery stenting (CAS). Methods: A systematic search was conducted to identify all randomized and observational studies published in English up to October 31, 2017, that compared open- vs closed-cell stent designs in CAS. Identified studies were included if they reported the following outcomes: stroke, transient ischemic attack (TIA), myocardial infarction (MI), hemodynamic depression, new ischemic lesions detected on imaging, and death within 30 days, as well as the incidence of in-stent restenosis. A random-effects model meta-analysis was employed. Model results are reported as the odds ratio (OR) and 95% confidence interval (CI). The I2 statistic was used to assess heterogeneity. Results: Thirty-three studies (2 randomized trials) comprising 20, 291 patients (mean age 71.3±3.0 years; 74.6% men) were included. Patients in the open-cell stent group had a statistically significant lower risk of restenosis ⩾40% (OR 0.42, 95% CI 0.19 to 0.92; I2=0%) and ⩾70% (OR 0.23, 95% CI 0.10 to 0.52; I2=0%) at a mean follow-up of 24 months. No statistically significant differences were identified for periprocedural stroke, TIA, new ischemic lesions, MI, hemodynamic depression, or death within 30 days after CAS. Sensitivity analysis of the 2 randomized controlled trials only did not point to any significant differences either. Conclusion: Use of open-cell stent design in CAS is associated with a decreased risk for restenosis when compared to the closed-cell stent, without significant differences in periprocedural outcomes.

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IYSC07. A Comparative Quantitative Analysis of Embolic Filter Debris Load During Carotid Artery Stenting, Between Open Cell, Closed Cell and Micromesh Stents

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.04.041 ◽

2019 ◽

Vol 69 (6) ◽

pp. e65

Author(s):

Michele Piazza ◽

Francesco Squizzato ◽

Chiara Chincarini ◽

Marny Fedrigo ◽

Annalisa Angelini ◽

...

Keyword(s):

Quantitative Analysis ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Open Cell ◽

Closed Cell

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Ischemic Complications after Carotid Artery Stenting Associated with Stent Cell Design: Closed-cell versus Open-cell Stents

Journal of Neuroendovascular Therapy ◽

10.5797/jnet.oa.2016-0112 ◽

2017 ◽

Vol 11 (7) ◽

pp. 327-332

Author(s):

Masataka Nanto ◽

Yudai Goto ◽

Hiroyuki Yamamoto ◽

Seisuke Tanigawa ◽

Hayato Takeuchi ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Cell Design ◽

Open Cell ◽

Closed Cell ◽

Ischemic Complications ◽

Cell Versus

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Stent Design, Restenosis and Recurrent Stroke After Carotid Artery Stenting in the International Carotid Stenting Study

Stroke ◽

10.1161/strokeaha.118.024076 ◽

2019 ◽

Vol 50 (11) ◽

pp. 3013-3020 ◽

Cited By ~ 2

Author(s):

Mandy D. Müller ◽

John Gregson ◽

Dominick J.H. McCabe ◽

Paul J. Nederkoorn ◽

H. Bart van der Worp ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Recurrent Stroke ◽

Carotid Stenting ◽

Hazard Ratio ◽

Stent Design ◽

Open Cell ◽

Closed Cell

Background and Purpose— Open-cell carotid artery stents are associated with a higher peri-procedural stroke risk than closed-cell stents. However, the effect of stent design on long-term durability of carotid artery stenting (CAS) is unknown. We compared the medium- to long-term risk of restenosis and ipsilateral stroke between patients treated with open-cell stents versus closed-cell stents in the ICSS (International Carotid Stenting Study). Methods— Patients with symptomatic carotid stenosis were randomized to CAS or endarterectomy and followed with duplex ultrasound for a median of 4.0 years. We analyzed data from patients with completed CAS procedures, known stent design, and available ultrasound follow-up. The primary outcome, moderate or higher restenosis (≥50%) was defined as a peak systolic velocity of >1.3 m/s on ultrasound or occlusion of the treated internal carotid artery and analyzed with interval-censored models. Results— Eight hundred fifty-five patients were allocated to CAS. Seven hundred fourteen patients with completed CAS and known stent design were included in the current analysis. Of these, 352 were treated with open-cell and 362 with closed-cell stents. Moderate or higher restenosis occurred significantly less frequently in patients treated with open-cell (n=113) than closed-cell stents (n=154; 5-year risks were 35.5% versus 46.0%; unadjusted hazard ratio, 0.68; 95% CI, 0.53–0.88). There was no significant difference in the risk of severe restenosis (≥70%) after open-cell stenting (n=27) versus closed-cell stenting (n=43; 5-year risks, 8.6% versus 12.7%; unadjusted hazard ratio, 0.63; 95% CI, 0.37–1.05). The risk of ipsilateral stroke beyond 30 days after treatment was similar with open-cell and closed-cell stents (hazard ratio, 0.78; 95% CI, 0.35–1.75). Conclusions— Moderate or higher restenosis after CAS occurred less frequently in patients treated with open-cell stents than closed-cell stents. However, both stent designs were equally effective at preventing recurrent stroke during follow-up. Clinical Trial Registration— URL: http://www.isrctn.com/ . Unique identifier: ISRCTN25337470.

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A Comparative Quantitative Analysis of Embolic Filter Debris Load During Carotid Artery Stenting, Between Open Cell, Closed Cell And Micromesh Stents

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.09.136 ◽

2019 ◽

Vol 58 (6) ◽

pp. e640-e641

Author(s):

Michele Piazza ◽

Francesco Squizzato ◽

Chiara Chincarini ◽

Marny Fedrigo ◽

Annalisa Angelini ◽

...

Keyword(s):

Quantitative Analysis ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Open Cell ◽

Closed Cell

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Angioplasty and carotid artery stenting: clinical and morphological factors affecting long-term outcomes

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2020-2470 ◽

2020 ◽

Vol 19 (3) ◽

pp. 2470

Author(s):

F. B. Shukurov ◽

E. S. Bulgakova ◽

B. A. Rudenko ◽

N. E. Gavrilova ◽

T. V. Tvorogova ◽

...

Keyword(s):

Carotid Artery ◽

Adverse Events ◽

Carotid Artery Stenting ◽

Lesion Length ◽

Open Cell ◽

Factors Affecting ◽

Residual Stenosis ◽

Stent Restenosis

Aim. To identify clinical and morphological factors affecting the longterm outcomes of endovascular angioplasty and carotid artery stenting.Material and methods. The analysis included 198 patients after carotid artery stenting between 03.2014 and 05.2018. There were following inclusion criteria: (1) 50% of symptomatic or 70% of asymptomatic carotid artery stenosis of according to NASCET (North American Symptomatic Carotid Endarterectomy Trial) criteria; (2) follow-up for each patient for at least 1 year. Using the univariate and multivariate logistic regression, risk factors associated with adverse events were determined.Results. The incidence of major adverse events during the 12-month follow-up was 9,6% (n=19), including 4 (2%) major and 6 (3%) minor strokes, 7 (3,5%) cases of transient ischemic attack; one (0,5%) patient had transient blindness and one (0,5%) died in the long-term follow-up period due to acute cerebrovascular accident in the target arterial territory. Also, 11 (5,6%) patients had restenosis >50% after 12-month follow-up. Multivariate analysis showed that long-term outcomes were significantly affected by: age >70 years (odds ratio (OR)=1,27, 95% confidence interval (CI): 1,07-1,61 (p=0,01); using of open-cell stents (OR=1,02, 95% CI: 1,01-1,03 (p=0,034)); contralateral stenosis (OR=1,28, 95% CI: 1,05-1,57 (p=0,01); lesion length >15 mm (OR=1,46, 95% CI: 1,12-1,89 (p=0,01)); residual stenosis <30% (OR=1,38, 95% CI: 1,09-1,49 (p=0,012)); complicated atherosclerotic plaque (OR=1,78, 95% CI: 1,21- 2,34 (p=0,007)). The development of in-stent restenosis was significantly influenced by factors such as the residual stenosis ><30% (OR=1,26, 95% CI: 1,1-1,65; p=0,017) and severe plaque calcification (OR=1,24, 95% CI: 1,04-1,31; p=0,02). Conclusion. The results obtained indicate the need for more careful preparation for endovascular intervention. Such factors as the use of open-cell stents, contralateral stenosis, lesion length >< 30% (OR=1,38, 95% CI: 1,09-1,49 (p=0,012)); complicated atherosclerotic plaque (OR=1,78, 95% CI: 1,21- 2,34 (p=0,007)). The development of in-stent restenosis was significantly influenced by factors such as the residual stenosis <30% (OR=1,26, 95% CI: 1,1-1,65; p=0,017) and severe plaque calcification (OR=1,24, 95% CI: 1,04-1,31; p=0,02).Conclusion. The results obtained indicate the need for more careful preparation for endovascular intervention. Such factors as the use of open-cell stents, contralateral stenosis, lesion length >15 mm, and residual stenosis < 30% may be associated with an increased risk of adverse events.

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Incidence of embolism associated with carotid artery stenting: open-cell versus closed-cell stents

Journal of Neurosurgery ◽

10.3171/2013.5.jns1331 ◽

2013 ◽

Vol 119 (3) ◽

pp. 642-647 ◽

Cited By ~ 26

Author(s):

Keun Young Park ◽

Dong Ik Kim ◽

Byung Moon Kim ◽

Hyo Suk Nam ◽

Young Dae Kim ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Artery Stenosis ◽

Smoking History ◽

Stent Design ◽

Open Cell ◽

Stent Type ◽

Asymptomatic Patients ◽

Closed Cell

Object Carotid artery stenting (CAS) can be an alternative option for carotid endarterectomy in the prevention of ischemic stroke caused by carotid artery stenosis. The purpose of this study was to evaluate the influence of stent design on the incidence of procedural and postprocedural embolism associated with CAS treatment. Methods Ninety-six symptomatic and asymptomatic patients, consisting of 79 males and 17 females, with moderate to severe carotid artery stenosis and a mean age of 69.0 years were treated with CAS. The stent type (48 closed-cell and 48 open-cell stents) was randomly allocated before the procedure. Imaging, procedural, and clinical outcomes were assessed and compared. The symptomatic subgroup (76 patients) was also analyzed to determine the influence of stent design on outcome. Results New lesions on postprocedural diffusion-weighted imaging (DWI) were significantly more frequent in the open-cell than in the closed-cell stent group (24 vs 12, respectively; p = 0.020). The 30-day clinical outcome was not different between the 2 stent groups. In the symptomatic patient group, stent design (p = 0.017, OR 4.173) and recent smoking history (p = 0.036, OR 4.755) were strong risk factors for new lesions on postprocedural DWI. Conclusions Stent design may have an influence on the risk of new embolism, and selecting the appropriate stent may improve outcome.

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