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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Stent Geometry Matters: Impact of Tapered vs. Straight Stents On Persistent Hemodynamic Depression After Carotid
Mustafa Demir1, Yunus Yasar1, Abdulbaki Agackiran2
1Department of Radiology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Türkiye.
Insights
Straight stents increase the risk of persistent hemodynamic depression (HD) after carotid artery stenting (CAS), unlike tapered stents. Choosing the right stent geometry, considering anatomy, can improve safety and reduce prolonged instability.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Biomedical Engineering
Background:
- Carotid Artery Stenting (CAS) is a key alternative to endarterectomy for high-risk patients.
- Persistent Hemodynamic Depression (HD) after CAS can impair cerebral perfusion.
- The influence of stent geometry on persistent HD is not well understood.
Purpose of the Study:
- To investigate the impact of stent geometry on persistent Hemodynamic Depression (HD) following Carotid Artery Stenting (CAS).
- To identify procedural and anatomical factors associated with prolonged hemodynamic instability post-CAS.
Main Methods:
- Retrospective analysis of 109 patients undergoing primary CAS.
- Definition of HD and persistent HD based on blood pressure and heart rate criteria.
- Evaluation of stent geometry (straight vs. tapered), carotid bulb involvement, and other procedural variables.
- Multivariable logistic regression to identify independent predictors of persistent HD.
Main Results:
- Persistent HD occurred in 25.7% of patients.
- Straight stents were associated with significantly higher rates of persistent HD (39.5%) compared to tapered stents (18.6%).
- Straight stent use and carotid bulb involvement were independently associated with persistent HD (OR 1.446 and 1.490, respectively).
Conclusions:
- Stent geometry and carotid bulb anatomy are significant procedural factors influencing persistent HD after CAS.
- Selecting anatomically conforming stents, such as tapered designs, may mitigate prolonged hemodynamic instability.
- Individualized device selection is crucial for improving periprocedural safety in CAS.
Introduction:
Carotid Artery Stenting (CAS) is an established alternative to carotid endarterectomy, particularly in patients with elevated surgical risk. Hemodynamic Depression (HD) is a common complication that is usually transient; however, persistent HD may compromise cerebral perfusion. The specific impact of stent geometry on persistent HD remains underexplored.
Methods:
This retrospective study included 109 patients who underwent primary CAS between October 2020 and October 2023. HD was defined as intraoperative hypotension (systolic blood pressure < 90 mmHg) and/or bradycardia (heart rate < 60 bpm), while persistent HD was defined as lasting more than 24 hours despite medical therapy. Patients were evaluated according to stent geometry (straight vs. tapered), carotid bulb involvement, plaque characteristics, and procedural variables. Multivariable logistic regression was performed, adjusting for demographic, clinical, anatomical, and procedural factors.
Results:
Periprocedural HD occurred in 40.4% of patients, and persistent HD in 25.7%. Persistent HD was significantly more frequent in patients treated with straight stents than in those treated with tapered stents (39.5% vs. 18.6%). Carotid bulb involvement and the use of a straight stent were significantly associated with persistent HD. In multivariable analysis, straight stent use (OR: 1.446; 95% CI: 1.041-2.018) and carotid bulb involvement (OR: 1.490; 95% CI: 1.102-2.015) remained independently associated with persistent HD. Twelve-month clinical outcomes did not differ between stent groups.
Discussion:
Persistent hemodynamic depression after carotid artery stenting appears to be influenced not only by patient-related factors but also by procedural characteristics, particularly stent geometry and carotid bulb anatomy. The independent association of straight stent use with prolonged hemodynamic instability underscores the clinical relevance of device selection beyond technical success. Incorporating anatomical conformity into preprocedural planning may reduce prolonged baroreceptor-mediated instability and improve periprocedural safety.
Conclusion:
Persistent HD is a clinically relevant complication after CAS. Individualized stent selection may help reduce prolonged hemodynamic instability.
