Closed-Cell Stents Present With Higher Velocities on Duplex Ultrasound Compared With Open-Cell Stents After Carotid Intervention: Short- and Mid-Term Results

Hussain, Hafiz G.; Aparajita, Ritu; Khan, Sikandar Z.; Rezayat, Combiz; McKinsey, James F.; Dayal, Rajeev

doi:10.1016/j.avsg.2010.07.004

Cited by 21 publications

(13 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We believe that the high stroke rate in the open-cell stent group is related to stent design. The potential advantage of closed-cell stents with a smaller free cell area and hence a greater percentage of wall coverage is that the stent may contain the fractured plaque after angioplasty, resulting in a lower number of postprocedural events [3]. …”

Section: Discussionmentioning

confidence: 99%

“…Extracranial carotid atherosclerosis with resulting atherothromboembolism may account for up to 30-40% of ischaemic strokes [2]. Thus, it leads to serious morbidity and mortality, and high cost to the health care system [3]. The mortality due to stroke has decreased in the last 50 years as a result of control of the risk factors, advances in pharmaceutical therapy, and development of effective interventions such as carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS) [3].…”

Section: Introductionmentioning

confidence: 99%

“…Thus, it leads to serious morbidity and mortality, and high cost to the health care system [3]. The mortality due to stroke has decreased in the last 50 years as a result of control of the risk factors, advances in pharmaceutical therapy, and development of effective interventions such as carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS) [3]. Despite numerous trials and clinical research, the optimal management of symptomatic and asymptomatic carotid disease remains controversial [4].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of short-term outcomes after carotid artery stenting according to different stent designs

Şahin

Açar

Özkan

et al. 2013

pwki

View full text Add to dashboard Cite

IntroductionIn the developed countries, stroke is the third most common cause of death. There are many data indicating that stents reduce the risk of embolism but there are few publications assessing whether different stent designs can influence the periprocedural complications.AimTo determine the effects of open- and closed-cell stent designs on 1-month results of carotid artery stenting (CAS).Material and methodsThe study group consisted of 290 consecutive patients (216 men and 74 women, mean age 66.6 ±8.7 years). Neuroprotection with a distal protection device was used in all cases. The patients were divided into two groups: the open-cell stent group (n = 144) and the closed-cell stent group (n = 138). Major adverse cardiac and cerebrovascular events (MACCE) described as myocardial infarction, stroke and death within 1 month were recorded and analysed subsequently. Periprocedural hypotension and transient cerebral ischaemia at 1 month after the CAS procedure were also assessed.ResultsWe treated 290 carotid stenoses and stents were implanted in all patients. Fifteen patients (5.5%) were treated by staged CAS due to bilateral carotid artery disease. The technical success rate was 97.2%. There was no difference in the MACCE and transient cerebral ischaemia rate at 1 month between the two groups (p = 0.44 and p = 0.94, respectively). The incidence of ischaemic stroke was lower in the closed-cell stent group (2.77% vs. 0%; p = 0.04). The periprocedural rate of hypotension was higher in the closed-cell stent group (2.1% vs. 7.2%; p = 0.04).ConclusionsClosed-cell stents are associated with a low rate of ischaemic stroke. We think that closed-cell stents may be preferred in patients at high risk of embolism.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of short-term outcomes after carotid artery stenting according to different stent designs

Şahin

Açar

Özkan

et al. 2013

pwki

View full text Add to dashboard Cite

show abstract

“…Hussain et al and Pierce et al have shown that stents with a closed cell design lead to a higher postinterventional increase of PSV than open-cell stents. 13,14 Therefore, it might be useful to test stent hemodynamics in a standardized ex vivo circulation model. A correction factor accounting for the stent-induced elevation in PSV/EDV could thereby be determined for each stent type.…”

Section: Discussionmentioning

confidence: 99%

“…11 Differentiating between severe in-stent restenosis and moderate in-stent restenosis plays an important role in deciding whether revision is necessary. [12][13][14] In the clinical setting, it is also relevant whether an increase in flow velocity is due to an early restenosis caused by neointimal hyperplasia or is due to hemodynamic change caused by the stent itself. Whether due to restenosis or stent-induced hemodynamic change, the compliance of the stented artery is reduced.…”

mentioning

confidence: 99%

Altered in-stent hemodynamics may cause erroneous upgrading of moderate carotid artery restenosis when evaluated by duplex ultrasound

Hakimi

Knez

Lippert

et al. 2012

Journal of Vascular Surgery

View full text Add to dashboard Cite

Clinical experience and prior studies support the supposition that restenosis after carotid artery stenting in carotid lesions displays erroneously elevated velocity when evaluated by duplex ultrasound (DUS), thus contributing to misleading interpretation of the degree of stenosis. This study, in contrast to studies of other groups, employs exactly the same conditions to measure flow with DUS in an unstented and then stented section of the carotid artery. Since DUS is the first-choice tool for carotid artery evaluation, knowledge about inexactness of the method is essential to avoid errors in treatment or follow-up decisions.

show abstract

Computational modeling of low‐density lipoprotein accumulation at the carotid artery bifurcation after stenting

Johari,

Menichini,

Hamady

et al. 2023

Numer Methods Biomed Eng

View full text Add to dashboard Cite

Restenosis typically occurs in regions of low and oscillating wall shear stress, which also favor the accumulation of atherogenic macromolecules such as low‐density lipoprotein (LDL). This study aims to evaluate LDL transport and accumulation at the carotid artery bifurcation following carotid artery stenting (CAS) by means of computational simulation. The computational model consists of coupled blood flow and LDL transport, with the latter being modeled as a dilute substance dissolved in the blood and transported by the flow through a convection‐diffusion transport equation. The endothelial layer was assumed to be permeable to LDL, and the hydraulic conductivity of LDL was shear‐dependent. Anatomically realistic geometric models of the carotid bifurcation were built based on pre‐ and post‐stent computed tomography (CT) scans. The influence of stent design was investigated by virtually deploying two different types of stents (open‐ and closed‐cell stents) into the same carotid bifurcation model. Predicted LDL concentrations were compared between the post‐stent carotid models and the relatively normal contralateral model reconstructed from patient‐specific CT images. Our results show elevated LDL concentration in the distal section of the stent in all post‐stent models, where LDL concentration is 20 times higher than that in the contralateral carotid. Compared with the open‐cell stents, the closed‐cell stents have larger areas exposed to high LDL concentration, suggesting an increased risk of stent restenosis. This computational approach is readily applicable to multiple patient studies and, once fully validated against follow‐up data, it can help elucidate the role of stent strut design in the development of in‐stent restenosis after CAS.

show abstract

Closed-Cell Stents Present With Higher Velocities on Duplex Ultrasound Compared With Open-Cell Stents After Carotid Intervention: Short- and Mid-Term Results

Cited by 21 publications

References 19 publications

Comparison of short-term outcomes after carotid artery stenting according to different stent designs

Comparison of short-term outcomes after carotid artery stenting according to different stent designs

Altered in-stent hemodynamics may cause erroneous upgrading of moderate carotid artery restenosis when evaluated by duplex ultrasound

Computational modeling of low‐density lipoprotein accumulation at the carotid artery bifurcation after stenting

Contact Info

Product

Resources

About