Key result
Carotid artery stenting shows continuous self-expansion, gaining ~12 percentage points in stent diameter at 12 months.
Why the study?
The extent of postoperative stent and lumen expansion after carotid artery stenting and the factors influencing these expansions during follow-up required evaluation.
Does self-expanding carotid artery stenting result in subsequent expansion of stent and vascular lumen diameters at 12-month follow-up in patients with carotid artery stenosis, and what plaque or stent factors influence this expansion?
Cohort (n=128)
No
Does self-expanding carotid artery stenting result in subsequent expansion of stent and vascular lumen diameters at 12-month follow-up in patients with carotid artery stenosis, and what plaque or stent factors influence this expansion?
Both self-expanding stents and the vascular lumen significantly dilate over 12 months following carotid artery stenting, but while fragile/soft plaques promote greater stent expansion, vascular lumen expansion remains unpredictable and unaffected by plaque fragility or stent cell design.
Answers are grounded in this paper and cite their sources.
Stent and lumen expansion occurs over 12 months post-stenting; extends device behavior data but leaves open effects on restenosis or stroke risk.
Purpose: We examined postoperative stent and lumen expansions after carotid artery stenting (CAS) in patients with carotid artery stenosis. Furthermore, we investigated factors influencing the stent and lumen expansions in a follow-up period. Subjects: 134 cases (128 patients) who underwent CAS and performed follow-up cerebral angiography 12 months after CAS were enrolled into this study. The stenosis rate based on the stent and lumen diameters on follow-up angiography as a percentage of that immediately after CAS was evaluated. Results: Both the stent and lumen diameters were significantly dilated 12 months after CAS (p <0.001). There were no significant stent-type-related differences in the stent expansion rate. In the symptomatic stenosis group, this expansion rate was significantly higher than in the asymptomatic stenosis group (p = 0.02). With respect to the presence or absence of a high signal intensity on time of flight (TOF) magnetic resonance (MR) images, the stent expansion rate was significantly higher in the high signal intensity group (p = 0.006). In patients with a plaque/sternocleidomastoid muscle signal intensity ratio of ≥1.50 on plaque images, it was significantly higher than in those with a value of <1.50 (p = 0.006). However, there were no significant differences in the lumen expansion rate among the groups. Conclusion: Both the stent and vascular lumen were dilated 12 months after CAS. Plaque fragility influenced the stent expansion rate; however, there were no significant factor-related differences in the vascular lumen expansion rate.
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Fujimoto et al. (2016) conducted a cohort in Carotid artery stenosis undergoing carotid artery stenting (CAS) (n=128). Carotid artery stenting (CAS) using self-expanding stents (PRECISE open-cell or Carotid Wallstent closed-cell) vs. Immediate post-CAS baseline vs 12-month follow-up (and comparisons by stent design, symptom status, and MRI plaque characteristics) was evaluated on Stent diameter and vascular lumen diameter ratio (stenotic site/distal diameter × 100) on plain X-ray and cerebral angiography at 12-month follow-up compared to immediately after CAS (p=<0.001). Carotid artery stenting resulted in significant self-expansion of both stent diameter (77.0% to 89.1%, p<0.001) and lumen diameter (77.8% to 82.5%, p=0.04) at 12 months.
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