Does free cell area influence the outcome in carotid artery stenting?
M Bosiers1, G de Donato, K Deloose
1Department of Vascular Surgery, AZ St-Blasius, Dendermonde, Belgium. marc.bosiers@telenet.be
Insights
Carotid stent design impacts stroke and TIA risk after carotid artery stenting (CAS). Open cell stents and larger free cell areas are linked to higher post-procedural complication rates, especially in symptomatic patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Biomedical Engineering
Background:
- Carotid artery stenting (CAS) is a common procedure to prevent stroke.
- Stent design may influence neurological complication rates following CAS.
- Understanding these design impacts is crucial for patient safety.
Purpose of the Study:
- To evaluate the association between carotid stent design, specifically free cell area and cell type, and 30-day neurological complication rates after CAS.
- To compare complication rates across different stent designs and types.
Main Methods:
- Retrospective analysis of a CAS database including 3179 consecutive patients.
- Assessment of neurological complication distribution in relation to stent types and designs.
- Subdivision of events into procedural and post-procedural categories.
Main Results:
- The overall 30-day rate of TIA, stroke, and death was 2.8%.
- Post-procedural event rates varied significantly by stent type (1.2% to 5.9%).
- Late event rates increased with larger free cell areas (1.2% to 3.4% for <2.5mm² vs >7.5mm²).
- Open cell designs had higher post-procedural event rates (3.4%) compared to closed cells (1.3%).
- These differences were more pronounced in symptomatic patients (p<0.0001).
Conclusions:
- Carotid stent type, free cell area, and cell design significantly influence complication rates post-CAS.
- Open cell stent designs are associated with higher post-procedural complication rates.
- Increasing free cell area correlates with increased complication rates, particularly in symptomatic patients.
Objectives:
To identify if carotid stent design, especially free cell area, impacts on the 30-day rates for stroke, death and TIA after carotid artery stenting (CAS).
Material And Methods:
A CAS database of 3179 consecutive CAS patients was retrospectively assessed. The distribution of neurological complications were analysed for association with the different stent types and designs. Events where subdivided into procedural and postprocedural events.
Results:
The overall combined rate of TIA, stroke and death was 2.8% at 30 days (late events 1.9%). The post-procedural event rate analyzed for differences stents varied from 1.2% using BSCI Carotid Wallstent to 5.9% using Medtronic Exponent. The late event rates varied from 1.2% to 3.4% for free cell areas <2.5mm(2) and >7.5mm(2) respectively (p<0.05). Post-procedural event rate was 1.3% for closed cells and 3.4% for open cells. All these differences were highly pronounced among symptomatic patients (p<0.0001).
Conclusions:
After carotid stenting, complication rates vary according to stent type, free cell area and cell design. In the symptomatic population (and also in the total population), post-procedural complication rates are highest for the open cell types and increase with larger free cell area.
