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Stent cell design does not affect 30-day outcomes after carotid stenting
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Results of a recent meta-analysis suggest that an open-cell stent design failed to reduce 30-day cerebrovascular complications with carotid artery stenting compared with a closed-cell design.
George N. Kouvelos, MD, PhD, from the University of Ioannina, Greece, and fellow researchers performed a systematic literature review that included nine studies — six of which were retrospective in design, two prospective and one registry.
In all, 8,018 patients (mean age, 70 years; 69% men) underwent 8,028 carotid artery stenting (CAS) procedures. Of the procedures, 4,018 were performed with open-cell stents and 4,010 with closed-cell stents. The open-cell stents included Acculink (Abbott Vascular; free cell area, 11.48 mm2), Exponent (Medtronic; 6.51 mm2), Precise (Cordis; 5.89 mm2) and Protégé (ev3; 10.71 mm2). The closed-cell stents including Adapt (Boston Scientific; 4.4 mm2), NexStent (Boston Scientific; 4.07 mm2), Wallstent (Boston Scientific; 1.08 mm2) and Xact (Abbott Vascular; 2.74 mm2). The analysis included one hybrid stent (Cristallo, Medtronic; 3.24 mm2 to 15.17 mm2).
Forty-three percent of patients were symptomatic, with no differences between the stent groups (open cell, 44.4% vs. closed cell, 41.7%; P = .93).
At 1 month, results indicated that the following complications were similar for open-cell vs. closed-cell groups: mortality (OR = 0.69; 95% CI, 0.39-1.24); transient ischemic attacks (OR = 0.95; 95% CI, 0.69-1.3); and stroke (OR = 1.17; 95% CI, 0.83-1.66).
“There is continuous refinement in CAS techniques based on selection of different endovascular devices for varying anatomic and plaque characteristics. Selection of the stent design should be incorporated into CAS treatment planning,” Kouvelos and colleagues wrote. “This meta-analysis showed that 30-day cerebrovascular complications after CAS are not significantly different for the open-cell stents in comparison to the closed-cell stents. Future prospective clinical trials comparing different free cell areas and other stent design properties are still needed to further investigate whether stent design constitutes a way to improve the results of CAS.” – by Brian Ellis
Disclosure: The researchers report no relevant financial disclosures.
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