Key result
Open-cell stents show no difference vs closed-cell stents in early post-procedural ischemic lesions on DWI.
Why the study?
Studies comparing outcomes of carotid artery stenting with open-cell stents versus closed-cell stents have yielded inconclusive results.
Does carotid artery stenting with open-cell stents compared to closed-cell stents reduce ischemic spots, restenosis, or recurrent stroke in patients with severe bilateral carotid stenosis?
Observational (n=52)
Does carotid artery stenting with open-cell stents compared to closed-cell stents reduce ischemic spots, restenosis, or recurrent stroke in patients with severe bilateral carotid stenosis?
Absolute Event Rate: 39% vs 17%
p-value: p=0.10
Open-cell and closed-cell stents show comparable rates of peri-procedural ischemia, long-term patency, and stroke recurrence in patients with severe bilateral carotid stenosis.
Similar ischemic lesion rates with open- versus closed-cell stents; leaves open optimal design and should not yet change practice in bilateral carotid stenosis.
Background: Carotid artery stenting (CAS) is an effective way to prevent stroke in patients with severe carotid stenosis. However, several studies comparing the outcomes of stenting with open-cell stents (OCS) vs closed-cell stents (CCS) have yielded inconclusive results. This study aimed to compare the outcomes of CAS with OCS vs CCS in the same patients. Methods: From year 2000 to 2016, we included 52 patients with severe bilateral carotid stenosis who underwent OCS deployment in one artery and CCS deployment in the contralateral artery. Stents were selected according to arterial anatomy and lesion morphology, and the peri-procedural and long-term outcomes of treatment with OCS vs CCS, were compared in terms of rates of ischemic spot development on early post-procedural diffusion-weighted imaging (ISDWI), in-stent restenosis (ISR), and recurrent stroke. Results: After stenting with OCS vs CCS, the number (rate) of arteries with no lesion, < 5 lesions, and ≥ 5 lesions on DWI was 9 (32%) vs 8 (27%), 8 (29%) vs 17 (57%), and 11 (39%) vs 5 (17%) (p = .10); number (rate) of arteries with 0%, < 50%, and >50% ISR was 34 (65%) vs 34 (65%), 9 (17%) vs 11 (21%), and 9 (17%) vs 7 (13%) (p = .71); number (rate) of recurrent strokes after CAS was 2 (4%) vs 0 (0%). Conclusion: The rates of peri-procedural cerebral ischemic insult, long-term stent patency, and stroke recurrence indicate that no one carotid stent cell design is superior to the other. We suggest both OCS and CCS are reasonable options for the treatment of severe carotid stenosis.
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Lee et al. (2019) conducted an observational in severe bilateral carotid stenosis (n=52). Open-cell stents vs. Closed-cell stents was evaluated on ≥ 5 lesions on early post-procedural diffusion-weighted imaging (p=0.10). Open-cell stents compared to closed-cell stents showed no significant difference in developing ≥5 ischemic lesions on early post-procedural diffusion-weighted imaging (39% vs 17%, p=0.10).
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