Long-term ultrasound follow-up in patients undergoing carotid stenting: differences in ultrasound parameters between closed-cell vs open-cell designed stents

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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PC120. Long-Term Outcomes Comparing Open-Cell vs Closed-Cell Stents for Carotid Stenting

Journal of Vascular Surgery ◽

10.1016/j.jvs.2015.04.286 ◽

2015 ◽

Vol 61 (6) ◽

pp. 149S-150S

Author(s):

Luis F. Gomez ◽

Carlos H. Timaran ◽

David E. Timaran ◽

Kimberly D. Borges ◽

Tarik Z. Ali

Keyword(s):

Carotid Stenting ◽

Long Term Outcomes ◽

Open Cell ◽

Closed Cell

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AS-54: Sex as an Independent Risk Factor for Adverse Events following Carotid Stenting for Carotid Artery Stenosis: Acute and Long-Term Follow-Up Results

The American Journal of Cardiology ◽

10.1016/j.amjcard.2009.01.099 ◽

2009 ◽

Vol 103 (9) ◽

pp. 25B

Author(s):

Chung-Ho Hsu ◽

Jen-Jyh Lin ◽

Ping-Han Lo ◽

Kuan-Chen Chang ◽

Jui-Sung Hung

Keyword(s):

Risk Factor ◽

Carotid Artery ◽

Adverse Events ◽

Carotid Artery Stenosis ◽

Independent Risk Factor ◽

Carotid Stenting ◽

Artery Stenosis ◽

Long Term Follow Up

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

Journal of Endovascular Therapy ◽

10.1177/1526602818783505 ◽

2018 ◽

Vol 25 (4) ◽

pp. 523-533 ◽

Cited By ~ 12

Author(s):

Pavlos Texakalidis ◽

Stefanos Giannopoulos ◽

Damianos G. Kokkinidis ◽

Giuseppe Lanzino

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Meta Analysis ◽

Stent Design ◽

Open Cell ◽

Stent Restenosis ◽

Closed Cell ◽

Ischemic Attack ◽

In Stent Restenosis

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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