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

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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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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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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Abstract W P17: Spontaneous Dilatation of Stents at Three Months After Carotid Artery Stenting Without Post-Carotid Artery Stenting Balloon Dilatation

Stroke ◽

10.1161/str.46.suppl_1.wp17 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Yuhei Tanno ◽

Takahisa Mori ◽

Tomonori Iwata ◽

Yoshinori Aoyagi ◽

Shigen Kasakura ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Balloon Dilatation ◽

Conventional Angiography ◽

Minimum Width ◽

Lateral Projection ◽

Closed Cell ◽

Dilatation Rate ◽

Stent Diameter

Objective: The aim of our retrospective study was to investigate how wide stents were spontaneously dilated at three months after carotid artery stenting (CAS) without post-CAS balloon dilatation (BT). Methods: We included in our analysis patients 1) who underwent elective CAS without post-CAS BT from January 2012 to March 2014, 2) who underwent follow-up conventional angiography at 3 months after CAS, Patients’ baseline characteristics, stent types (open cell: OP or closed cell: CL), stent diameter (SD) at the site with minimum width on the lateral projection immediately and at 3 month after CAS were evaluated. Results: Sixty-two lesions in fifty-nine patients were analyzed. Their average age was 74.9 years old, median SD immediately after CAS was 3.27mm(3.08_3.64:interquartile range), median SD at 3 months was 3.99mm(3.58-4.27), and thus SD was spontaneously dilated (p<0.0001). In OP types (18 cases), median SD changed from 3.59 to 4.05 mm and in CL types (44 cases) from 3.22 to 3.85 mm. Median SD after deployment was wider in OP type anytime (p<0.05), whereas dilatation rate seemed to be bigger in CL type. Conclusion: Stents were spontaneously dilated about 10 to 20% without post-CAS balloon dilatation. SD at 3 months was wider in OP type, whereas dilatation rate at 3 months was bigger in CL type.

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P-001 Carotid artery stenting using overlapped double closed-cell stents for unstable plaque

10.1136/neurintsurg-2019-snis.37 ◽

2019 ◽

Author(s):

K Takayama ◽

K Myouchin ◽

T Wada ◽

S Kurokawa ◽

K Kichikawa

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Unstable Plaque ◽

Closed Cell

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Efficacy of post-dilatation during carotid artery stenting for unstable plaque using closed-cell design stent evaluated by optical coherence tomography

Journal of Neuroradiology ◽

10.1016/j.neurad.2019.03.006 ◽

2019 ◽

Vol 46 (6) ◽

pp. 384-389 ◽

Cited By ~ 2

Author(s):

Kei Harada ◽

Masahito Kajihara ◽

Yukihiro Sankoda ◽

Syunsuke Taniguchi

Keyword(s):

Optical Coherence Tomography ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Cell Design ◽

Optical Coherence ◽

Unstable Plaque ◽

Closed Cell

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Optical coherence tomography evaluation of tissue prolapse after carotid artery stenting using closed cell design stents for unstable plaque

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2017-013004 ◽

2017 ◽

Vol 10 (3) ◽

pp. 229-234 ◽

Cited By ~ 8

Author(s):

Kei Harada ◽

Shogo Oshikata ◽

Masahito Kajihara

Keyword(s):

Optical Coherence Tomography ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Cell Design ◽

Optical Coherence ◽

Cross Sectional ◽

Closed Cell ◽

Procedural Complications ◽

Oct Imaging ◽

Unstable Plaques

Background and purposeDuring carotid artery stenting (CAS) with the use of closed cell design stents for unstable plaques, tissue prolapse between stent struts was evaluated by optical coherence tomography (OCT).Methods14 carotid stenosis lesions diagnosed as unstable plaques by MRI were evaluated by OCT imaging during CAS using closed cell stents. Cross sectional OCT images within the stented segment were evaluated at 1 mm intervals. The slice rate for the presence of tissue prolapse between the struts was calculated.ResultsNo intra-procedural complications occurred. After single stent placement, plaque prolapse was observed in all cases. Slices with any and >500 µm tissue prolapse were seen in 30% and 7.8% of cases, respectively. In 5 of 7 lesions with tissue prolapse >500 µm, additional stents were overlapped. In cases with overlapping stents, slices with any tissue prolapse were significantly decreased from 26% to 16% (p=0.008); in particular, the occurrence of tissue prolapse >500 µm was significantly decreased from 15% to 2.3% (p<0.001). In one case of >500 µm tissue prolapse without an overlapping stent, delayed embolization due to an in-stent thrombus occurred 9 months after the procedure.ConclusionsOCT during CAS using closed cell stent for unstable plaques frequently revealed tissue prolapse between struts. Placement of overlapping stents significantly reduced tissue prolapse, particularly tissue prolapse >500 µm. However, closed cell stents used for unstable plaques may not solve the problem of tissue prolapse.

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