Comparison of closed-cell and hybrid-cell stent designs in carotid artery stenting: clinical and procedural outcomes

Abstract

IntroductionCarotid artery stenting (CAS) is a promising alternative to surgery in high-risk patients. However, the impact of stent cell design on outcomes in CAS is a matter of continued debate.AimTo compare the periprocedural and clinical outcomes of different stent designs for CAS with distal protection devices.Material and methodsAll CAS procedures with both closed- and hybrid-cell stents performed at our institution between February 2010 and December 2015 were analyzed retrospectively. Adverse events were defined as death, major stroke, minor stroke, transient ischemic attack and myocardial infarction. Periprocedural and 30-day adverse events and internal carotid artery (ICA) vasospasm rates were compared between the closed-cell and hybrid-cell stent groups.ResultsThe study included 234 patients comprising 146 patients with a closed-cell stent (Xact stent, Abbott Vascular) (mean age: 68.5 ±8.6; 67.1% male) and 88 patients with a hybrid-cell stent (Cristallo Ideale, Medtronic) (mean age: 67.2 ±12.8; 68.2% male). There was no significant difference between the groups with respect to periprocedural or 30-day adverse event rates. While there was no difference in terms of tortuosity index between the groups, there was a higher procedural ICA vasospasm rate in the closed-cell stent group (35 patients, 23%) compared with the hybrid-cell stent group (10 patients, 11%) (p = 0.017).ConclusionsThe results of this study showed no significant difference in the clinical adverse event rates after CAS between the closed-cell stent group and the hybrid-cell stent group. However, procedural ICA vasospasm was more common in the closed-cell stent group.

One swallow does not a summer make but many swallows do: accumulating clinical evidence for nearly-eliminated peri-procedural and 30-day complications with mesh-covered stents transforms the carotid revascularisation field

“…Similarly, analysis of adverse outcome predictors in 828 patients randomised to the CAS arm of the International Carotid Stenting Study (ICSS), demonstrated that use of an open-cell stent conferred a statistically significant two-fold higher risk of stroke by 30 days than use of a closed-cell stent (relative risk (RR) = 1.92, 95% CI: 1.11–3.33) [ 48 ]. There are theoretical grounds and there is some moderate-scale evidence that hybrid stents, which combine the open-cell design advantage of high conformability (proximal and distal stent section) with the closed-cell design of the mid-section of the stent aimed to cover the plague, may be non-inferior to closed-cell stents [ 49 ].…”

Asymptomatic Cerebral Emboli Following Carotid Artery Stenting: A Diffusion-Weighted MRI Study

“… 27 One of the most common complications of closed-cell stents is vasospasm at the distal side of the carotid artery, leading to slow flow. 28 …”

Transcervical Carotid Artery Stenting Without Flow Reversal: A Report of Two Cases

“…The advantage of the open-cell or hybrid cell designs is to allow flexibility when used in patients with angulated or tortuous vessels. The results of a previously published study showed no significant difference in adverse event rates, including embolization following CAS, between the closed-cell stent group and the hybrid-cell stent group [11]. However, procedural internal carotid artery vasospasm more frequently occurred in the closed-cell stent group [11].…”