Does carotid stent cell design matter?
OBJECTIVE
Carotid stent cell design has recently been suggested to be a determinant of periprocedural and early postprocedural neurologic complications. We investigated the impact of closed- versus open-cell stent design on neurologic adverse events and mortality after carotid artery stenting.


METHODS
We studied 1684 consecutive patients (1010 asymptomatic, 674 symptomatic) from 10 European centers who underwent carotid artery stenting with either closed-cell (n=859, 51%) or open-cell (n=825, 49%) design stents. Rates of transient ischemic attack, stroke, and death on the day of the procedure (acute events) and from day 1 to day 30 after the procedure (subacute events) were analyzed (95% CIs).


RESULTS
Combined transient ischemic attack, stroke, or death rates, and stroke or death rates within 30 days of treatment were 6.1% (95% CI, 5.0 to 7.2) and 3.1% (95% CI, 2.3 to 3.9) for the closed-cell design versus 4.1% (95% CI, 3.2 to 5.0) and 2.4% (95% CI, 1.7 to 3.1) for the open-cell design stents (P=0.077, P=0.38), respectively, without significant differences in asymptomatic and symptomatic patients. By propensity-score-adjusted multivariable analysis, the open-cell carotid stent design was not associated with a differential risk for combined acute and subacute neurologic complications compared with closed-cell stents (adjusted odds ratio=0.84, P=0.53). When analyzed separately, the risk for acute events on the day of the procedure (adjusted odds ratio=0.83, P=0.57) and the risk for subacute events at days 1 to 30 (adjusted odds ratio=1.61, P=0.51) also were not significantly different between the groups.


CONCLUSIONS
Current data do not support the superiority of a specific carotid stent cell design with respect to neurologic complications, stroke, and mortality risk.
Schillinger
Martin
M
Department of Angiology, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. martin.schillinger@meduniwien.ac.at
Gschwendtner
Manfred
M
Reimers
Bernhard
B
Trenkler
Johannes
J
Stockx
Luc
L
Mair
Johann
J
Macdonald
Sumaira
S
Karnel
Franz
F
Huber
Kurt
K
Minar
Erich
E
D000368:Aged; D002340:Carotid Artery Diseases / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology* / Q000401:mortality; D018570:Risk Assessment; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000209:etiology; D013997:Time Factors