A meta-analysis of the effect of stent design on clinical and radiologic outcomes of carotid artery stenting

Vries, Evelien E. de; Meershoek, Armelle J.A.; Vonken, Evert Jan; Ruijter, Hester M. den; Berg, Jos C. van den; Borst, Gert J. de; Bijuklic, Klaudija; Schöfer, Joachim; Bonati, Leo H.; Bosiers, Marc; Wauters, Jeroen; Donato, Gianmarco de; Chisci, Emiliano; Setacci, Carlo; Doig, David; Featherstone, Roland L.; Dobson, Joanna; Brown, Martin M.; Eskandari, Mark K.; Giri, Jay; Grunwald, Iris Q.; Kühn, Anna Luisa; Han, Deting; Faries, Peter L.; Hernández-Fernández, F.J.; Parrilla, G.; Hornung, Marius; Sievert, Horst; Kono, Kenichi; Latacz, Paweł; Ledwoch, Jakob; Mudra, Harald; Maleux, Geert; Nolz, Richard; Ohki, Takao; Piazza, Michele; Pienia̦żek, Piotr; Tekieli, Łukasz; Radak, Djordje; Tanasković, Slobodan; Rašiová, Mária; Simonte, Gioele; Fiorucci, Beatrice; Tietke, Marc; Ventoruzzo, Giorgio

doi:10.1016/j.jvs.2018.11.017

Cited by 27 publications

(18 citation statements)

References 76 publications

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“…The use of closed-cell stents could also account for the low stroke rate in our study. Superiority of the closed-cell stents in comparison with the opencell ones has already been demonstrated in several trials [23][24][25]. In 29 patients we implanted modern dual-layered stents (the RoadSaver stents).…”

Section: Discussionmentioning

confidence: 94%

Mid-term and late results of endovascular treatment for symptomatic carotid artery stenosis under proximal protection

Latacz¹,

Simka²,

Krzanowski³

et al. 2021

wiitm

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Introduction: Although filters are still preferred during carotid stenting, proximal protection systems (PPS) are increasingly used during these procedures. PPS seem to be safer than distal systems, especially in symptomatic patients, but evidence supporting their use is limited. Aim: This was a post hoc survey with 30-day mid-term and long-term follow up, which was aimed at assessment of the safety and efficacy of stenting of the internal carotid artery under PPS in symptomatic patients. Material and methods: We analysed the results of stenting in 120 symptomatic patients presenting with at least 60% stenosis. Patients were aged 67.9 ±9.8 years, and 12 patients were older than 80 years. An occlusion of contralateral artery was found in 5 patients and bilateral stenosis in 26 patients. The primary endpoint of this study was the proportion of patients who had new neurological events, including transient ischemic attack and minor or major stroke in 30-day follow-up. The secondary endpoint was a composite of technical and clinical success. During longterm follow-up we assessed new neurological events and stenoses of implanted stents. Results: The incidence of new neurological events during 30-day follow-up was 0.8%. The rate of technical success defined by secondary endpoint was 100%. Mean internal carotid artery stenosis before and after stent implantation was 93.8 ±9% and 8.4 ±6.3%, respectively (p < 0.001). Procedural success was achieved in all cases. During longterm follow-up there were two (1.7%) asymptomatic in-stent stenoses and no (0%) new neurological events. Conclusions: Endovascular management of symptomatic carotid stenosis under PPS is safe, feasible, and appears to be a good alternative to surgical endarterectomy.

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Section: Discussionmentioning

confidence: 94%

Mid-term and late results of endovascular treatment for symptomatic carotid artery stenosis under proximal protection

Latacz¹,

Simka²,

Krzanowski³

et al. 2021

wiitm

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“…34 A meta-analysis investigating stent design found no differences in terms of major adverse events but found an increased risk of development of peri-procedural DWI lesions in patients treated with open cell stenting. 40 Administration of additional pre-procedural anticoagulants and additional lipid lowering therapy may be protective for development of new DWI lesions. 35,36,41 Another topic of interest is procedural timing in symptomatic patients.…”

Section: Discussionmentioning

confidence: 99%

Editor's Choice – Predictors of New Ischaemic Brain Lesions on Diffusion Weighted Imaging After Carotid Stenting and Endarterectomy: A Systematic Review

Rots

Meershoek

Bonati

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS STUDY ADDS This systematic review presents an overview of the available evidence on patient related features associated with an increased susceptibility to the development of new ischaemic brain lesions on magnetic resonance diffusion weighted imaging after carotid endarterectomy and carotid artery stenting. These demographic, radiological, and biochemical predictors may be helpful in decision making on patient selection for medical intervention, carotid stenting, or endarterectomy.Objectives: Peri-procedural ischaemic brain lesions on diffusion weighted imaging (DWI) after carotid endarterectomy (CEA) and carotid artery stenting (CAS) have been related to a higher chance of recurrent cerebrovascular events. This systematic review provides an overview of patient characteristics associated with increased risk of new DWI lesions. Methods: MEDLINE, EMBASE, and Cochrane library databases were systematically searched (update November 2018) for studies reporting post-procedural DWI lesions after CEA or CAS. Data derived from both procedures were analysed separately. Studies reporting predictive features that were present prior to intervention were assigned to 10 categories: age, gender, cardiovascular risk factors, symptomatology, plaque vulnerability, atherosclerotic burden, cerebrovascular haemodynamics, carotid/arch anatomy, inflammatory markers, and markers of coagulation. A semi-quantitative analysis was performed by plotting studies that found an association between the investigated features and DWI lesions against those that did not find an association. Results: Forty-six studies (5018 patients) were included: 10 reported only CEA, 33 CAS, and three both interventions. 68.0% of 1873 CEA patients and 55.9% of 3145 CAS patients were symptomatic. The weighted prevalence of DWI lesions was 18.1% (95% CI 14.0e22.7%) in CEA patients compared with 40.5% (95% CI 35.4e45.7%) in CAS patients. Studies reporting on CEA patients predominantly found an increased risk in symptomatic patients (two of seven studies, including 848/1661 patients), those with impaired haemodynamics (five of five studies), and increased inflammatory markers (two of three studies). Studies reporting on CAS patients often found a positive association with age (10/26 studies), high plaque vulnerability (25/34 studies), or complex carotid/arch anatomy (three out of five studies). Conclusions: For patients undergoing CEA, symptomatic status, impeded cerebral haemodynamics, and increased inflammatory markers are associated with increased susceptibility to peri-operative DWI lesions. In CAS patients, higher age, plaque vulnerability and complex carotid/aortic arch anatomy were identified as risk factors. These clinical predictors may assist with decision making on patient selection for medical treatment, CEA or CAS.

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“…40 Interventionalists realized earlyon that open-cell stent design doubled the risk of postprocedural stroke in the SPACE and ICSS trials, and so modern stents used for carotid revascularization are closedcell in design. 41,42 Techniques that have a high risk of causing stroke during the CAS procedure, such as dilating after stent deployment, have been identified so that interventionalists can make informed decisions regarding use of these techniques. 43 CAS is safest when performed in a multidisciplinary environment with an experienced team.…”

Section: Choice Of Carotid Endarterectomy Versus Stentingmentioning

confidence: 99%

Carotid Revascularization: Current Practice and Future Directions

Bagley

Priest

2020

Semin intervent Radiol

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Carotid stenosis is responsible for approximately 15% of ischemic strokes. Carotid revascularization significantly decreases patients' stroke risk. Carotid endarterectomy has first-line therapy for moderate-to-severe carotid stenosis after a series of pivotal randomized controlled trials were published almost 30 years ago. Revascularization with carotid stenting has become a popular and effective alternative in a select subpopulation of patients. We review the current state of the literature regarding revascularization indications, patient selection, advantages of each revascularization approach, timing of intervention, and emerging interventional techniques, such as transcarotid artery revascularization.

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A meta-analysis of the effect of stent design on clinical and radiologic outcomes of carotid artery stenting

Cited by 27 publications

References 76 publications

Mid-term and late results of endovascular treatment for symptomatic carotid artery stenosis under proximal protection

Mid-term and late results of endovascular treatment for symptomatic carotid artery stenosis under proximal protection

Editor's Choice – Predictors of New Ischaemic Brain Lesions on Diffusion Weighted Imaging After Carotid Stenting and Endarterectomy: A Systematic Review

Carotid Revascularization: Current Practice and Future Directions

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