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

Download Full-text

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

Download Full-text

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

Download Full-text

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.

Download Full-text

Carotid Artery Stenting Using a Closed-Cell Stent-in-Stent Technique for Unstable Plaque

Journal of Endovascular Therapy ◽

10.1177/1526602819847698 ◽

2019 ◽

Vol 26 (4) ◽

pp. 565-571 ◽

Cited By ~ 3

Author(s):

Kaoru Myouchin ◽

Katsutoshi Takayama ◽

Takeshi Wada ◽

Toshiteru Miyasaka ◽

Toshihiro Tanaka ◽

...

Keyword(s):

Carotid Artery ◽

Success Rate ◽

Carotid Artery Stenting ◽

Technical Success ◽

Unstable Plaque ◽

Technical Success Rate ◽

Closed Cell ◽

Lumen Narrowing ◽

Ischemic Complications

Purpose: To examine whether carotid artery stenting (CAS) of stenoses with unstable plaque using a closed-cell stent-in-stent technique prevents plaque protrusion. Materials and Methods: Between December 2014 and August 2018, 35 consecutive patients (mean age 75.8 years; 29 men) with carotid artery stenosis (20 symptomatic) and unstable plaque diagnosed by magnetic resonance imaging were prospectively analyzed. Mean diameter stenosis was 83.5%. All CAS procedures were performed with stent-in-stent placement of Carotid Wallstents using an embolic protection device and conservative postdilation. The technical success rate, incidence of plaque protrusion, ischemic stroke rate within 30 days, and new ipsilateral ischemic lesions on diffusion-weighted imaging (DWI) within 48 hours after CAS were prospectively assessed. Follow-up outcomes included the incidences of ipsilateral stroke and restenosis. Results: The technical success rate was 100%. No plaque protrusion or stroke occurred in any patient. New ischemic lesions were observed on DWI in 10 (29%) patients. During the mean 11.6-month follow-up, no ipsilateral strokes occurred. Two (6%) patients developed asymptomatic restenosis recorded as 53% lumen narrowing and occlusion, respectively. Conclusion: CAS using a closed-cell stent-in-stent technique for unstable plaque may be useful for preventing plaque protrusion and ischemic complications.

Download Full-text

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.

Download Full-text

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

Download Full-text

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.

Download Full-text

CAR 16. 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.2019.08.137 ◽

2019 ◽

Vol 70 (5) ◽

pp. e166-e167

Author(s):

Michele Antonello ◽

Francesco Squizzato ◽

Andrea Xodo ◽

Chiara Chincarini ◽

Franco Grego ◽

...

Keyword(s):

Quantitative Analysis ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Open Cell ◽

Closed Cell

Download Full-text

Low-profile visualized intraluminal support Blue stenting within a Neuroform Atlas stent for a large wide-necked aneurysm: A case report and a bench-top experiment

The Neuroradiology Journal ◽

10.1177/19714009211026900 ◽

2021 ◽

pp. 197140092110269

Author(s):

Tomoko Hayashi ◽

Hiroyuki Ikeda ◽

Ryota Ishibashi ◽

Toshio Fujiwara ◽

Ryosuke Kaneko ◽

...

Keyword(s):

Case Report ◽

Coil Embolization ◽

Cell Design ◽

Open Cell ◽

Aneurysm Neck ◽

Low Profile ◽

Closed Cell ◽

High Metal ◽

Silicon Tube ◽

Aneurysm Occlusion

Low-profile visualized intraluminal support deployment in an Enterprise has been reported; however, that in an Atlas has yet to be in detail. Enterprise has a closed-cell design, while Atlas has an open-cell design. We detail here a case of a large wide-necked aneurysm treated by coil embolization with low-profile visualized intraluminal support Blue deployment within a Neuroform Atlas and a bench-top experiment using a silicon tube to test low-profile visualized intraluminal support, Atlas, Enterprise, and their combinations. A better low-profile visualized intraluminal support expansion was achieved by simultaneously pushing the wire and the system within the Atlas placed at the aneurysm neck, which resulted in an increased metal coverage of the aneurysm neck and a shorter transition zone with low metal coverage at both ends of the aneurysm neck. This technique may enable a high metal coverage by low-profile visualized intraluminal support expansion without restriction by the Atlas and contribute to aneurysm occlusion by increasing the flow-diverting effect.

Download Full-text