Do device characteristics impact outcome in carotid artery stenting?

Abstract

We conclude that increased analysis of device design variables may be necessary. Particularly in symptomatic patients or with echolucent lesions, closed-cell design and eccentric filters seem superior. Prospective investigation comparing open-cell vs closed-cell stents and eccentric vs concentric filter devices may be warranted.

Effects of Age and Symptom Status on Silent Ischemic Lesions after Carotid Stenting with and without the Use of Distal Filter Devices

“…31 Moreover, most patients were treated with an open-cell design stent (Precise, Cordis) in this study. In a recent study, patients treated with open-cell design stents had significantly higher stroke and death rates after CAS than those treated with closed-cell design stents, 32 indicating that the latter type of stents might have an intrinsically greater potential to prevent embolism of fractured plaque or other thrombogenic material to the brain. Finally, our results could also have been influenced by the use of 4 different distal filter devices, which might not be equally effective in preventing thromboembolic complications during CAS.…”

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

“…[245][246][247][248][249][250][251] If properly deployed, an EPD can reduce the neurological risks associated with CAS, but these devices may also be associated with failures. 53,196,198,247,[252][253][254][255][256][257][258] Among the general risks is access-site injury, which complicates 5% of cases, but most such injuries involve pain and hematoma formation and are self-limited. [259][260][261][262] Contrast-induced nephropathy has been reported in <1% of cases, because CAS is generally avoided in patients with severe renal dysfunction.…”

Ischemic Complications after Carotid Artery Stenting Associated with Stent Cell Design: Closed-cell versus Open-cell Stents

“…10,11) In these reports, especially in symptomatic patients, the choice of closed-cell stents resulted in a significant decrease in postprocedural embolic events, due to the low free cell area in closed-cell stents. Hart et al 10) reported that closed-cell stent designs cover a In addition, greater complexity of hematologic factors may contribute to the superiority of closed-cell stent designs. Indeed, increased platelet activation after coronary stent placement has previously been reported.…”

“…Logically, closedcell stent designs cover a greater percentage of the vascular wall within the stented region, and may better contain the fractured and dilated plaque during CAS compared with open-cell stent designs. 10,11) However, the effects of stent cell design on cerebral ischemic complications after tailored CAS are not well understood. Thus, the purpose of this study was to assess the outcomes following tailored CAS in a cohort of patients managed at our institution and to evaluate the influence of stent cell design on the incidence of periprocedural cerebral embolism in CAS.…”