Will mesh-covered stents help reduce stroke associated with carotid stent angioplasty?
Carly N Richards1, Peter A Schneider1
1Division of Vascular Therapy, Kaiser Foundation Hospital and Department of Surgery, Tripler Army Medical Center, 3288 Moanalua Road, Honolulu, HI 96819.
Insights
Carotid stent angioplasty (CAS) offers long-term stroke protection comparable to carotid endarterectomy (CEA). Novel stent designs minimizing open struts may reduce post-procedure embolization and expand CAS applications.
Area of Science:
- Vascular surgery
- Interventional cardiology
- Neurology
Background:
- Carotid stent angioplasty (CAS) provides long-term stroke prevention, similar to carotid endarterectomy (CEA).
- A higher risk of perioperative stroke exists with CAS compared to CEA.
- Neurologic events post-CAS often occur days after stent deployment, suggesting stent-related mechanisms.
Purpose of the Study:
- To investigate the mechanisms of perioperative stroke risk in CAS.
- To evaluate the potential of improved carotid stent designs in mitigating stroke risk.
- To identify factors for expanding CAS application in severe internal carotid artery stenosis.
Main Methods:
- Analysis of perioperative stroke occurrence in CAS patients.
- Evaluation of neurologic event timing relative to stent deployment.
- Assessment of carotid stent designs, focusing on strut coverage and embolization potential.
Main Results:
- A significant portion of neurologic events occur 1-30 days post-CAS.
- Plaque embolization through stent struts is a suspected mechanism for stroke.
- Carotid stent designs with mesh coverings appear to reduce embolization risk.
Conclusions:
- Stent design is crucial for minimizing post-procedural embolization in CAS.
- Improvements in stent design can reduce stroke risk associated with CAS.
- Optimized stent designs may broaden the use of CAS for severe carotid artery stenosis.
Abstract:
Carotid stent angioplasty (CAS) has been shown to protect patient from future stroke long-term efficacy similar to carotid endarterectomy (CEA). The risk of minor stroke in the perioperative period is higher than with CEA and not related to cerebral protection during the CAS procedure since a significant portion of the neurologic events occur between 1 and 30 days following stent deployment. This observation suggests mechanisms integral to the stent itself may be pertinent such as plaque embolization thru the stent struts may occur. It appears that this embolic risk can be reduced by use of specific carotid stent designs that include a mesh covering to minimize the open struts areas and thus embolization through the carotid stent. Improvements in stent design that eliminate post-procedural debris embolization will expand the application of CAS for severe internal carotid artery atherosclerotic stenosis.
