Surgical removal of self-expanding stents from the carotid artery: does the type of stent make a difference?
OBJECTIVE
To evaluate the degree of difficulty in surgically removing 2 different stent models placed in the canine carotid artery.


METHODS
In 5 dogs, each carotid artery was stented with a braided Elgiloy self-expanding stent (BESES) on one side and a surface-spanning micro stent (SSMS) on the other. After 4 weeks, an arteriogram was obtained, and the stents were removed via direct surgical exposure. The minimum lengths of the skin incisions and arteriotomies, the ease of stent removal, and the presence of a distal intimal flap were recorded.


RESULTS
Stent deployment and removal were successful in each animal, but there was a substantial difference in the ease of removal. The BESES could be removed in a strand-by-strand fashion via a more proximal, smaller arteriotomy compared to the SSMS (8.8+/-1.3 versus 37.2+/-4.7 mm, p<0.01). Furthermore, a smaller skin incision (3.85+/-0.9 versus 9.75+/-0.5 cm, p<0.01) was required for the BESES. There was no distal flap formation following BESES removal, whereas SSMS removal produced a large distal flap in each artery (p<0.01).


CONCLUSIONS
Although rare, restenosis after stenting occurs, and surgical repair may become necessary in some patients. Each stent has inherent advantages and disadvantages, but the braided Elgiloy self-expanding stent lends itself to easier surgical removal, which may have important clinical implications, especially when used in the carotid artery.
Shaw
Palma M
PM
Department of Surgery, Division of Vascular Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York 10467, USA.
Ohki
Takao
T
Veith
Frank J
FJ
Dadian
Nishan
N
D000818:Animals; D002339:Carotid Arteries / Q000601:surgery*; D020878:Device Removal; D004285:Dogs; D004867:Equipment Design; D005240:Feasibility Studies; D008297:Male; D015607:Stents