Carotid artery stenting with open vs closed stent cell configurations in the CREST-2 Registry

Document Type

Conference Proceeding

Publication Date

7-1-2025

Publication Title

Eur J Vasc Endovasc Surg

Keywords

anticoagulant agent, adult, aged, atherosclerosis, carotid artery stent, carotid artery stenting, cerebrovascular accident, clinical outcome, complication, conference abstract, drug combination, drug therapy, female, Food and Drug Administration, human, major clinical study, male, patient preference, restenosis, self expandable metallic stent, stent, surgery, therapy

Abstract

Objective: Intraprocedural atheroembolization during carotid artery stenting (CAS) can be reduced through careful patient selection, consideration of vascular anatomy and lesion characteristics, operator and institutional experience, peri-procedural antithrombotic and antiplatelet therapy, and use of embolic protection. However, CAS can also result in stroke as the stent is deployed and embolic protection withdrawn. The free-cell area of most closed-cell stents is <5 mm2, and ≥5 mm2 for open-cell stents. The larger area may permit escape of more atheromatous debris. Comparisons of clinical outcomes between closed-cell and open-cell stents have been inconclusive. The aim of this study is to compare clinical outcomes associated with CAS using open-cell vs closed-cell stents. Methods: The CREST-2-Registry (C2R) enrolls asymptomatic and symptomatic patients for whom CAS is favored because of high risk for surgery or patient preference. C2R implements operator- and site-credentialing, careful lesion selection, and standardized procedural protocols. Patient characteristics, procedural details, and outcomes are recorded. Interventionists may use United States Food and Drug Administration-approved devices including open-cell stents (Rx Acculink [Abbott Vascular], Precise Pro Rx [Cordis-Cardinal Health], and Protégé Rx [Medtronic/Covidien]), or closed-cell stents (XACT [Abbott Vascular] and Wallstent Monorail Endoprosthesis [Boston Scientific]). Multivariable logistic regression was used to assess relate stent cell configuration to peri-procedural (30-day) stroke or death (SD). Results: Of 5307 procedures performed by 163 interventionists across 101 clinical centers, 2054 (38.7%) received open-cell stents, and 3253 (61.3%) received closed-cell stents. In the periprocedural period, 91 patients (1.7%) experienced a stroke (3 were fatal), and 16 patients died without experiencing strokes (0.4%). After adjusting for age, sex, symptomatic status, and case urgency, and for effect-modification by indication, periprocedural SD was significantly higher when an open-cell stent was placed in a primary lesion compared with closed-cell stents (3.5 events per 100 procedures using open-cell stents [95% confidence interval [CI], 2.6-4.7] vs 2.2% [95% CI, 1.6-3.0] using closed-cell stents (odds ratio, 1.59; 95% CI, 1.13-2.23; P < .01). Periprocedural SD was not significantly different between stent types when placed in a restenotic lesion (1.2% [95% CI, 0.4-3.3]) using open-cell stents vs 4.0% (95% CI, 2.2-7.2) using closed-cell stents (odds ratio, 0.31; 95% CI, 0.09-1.01; P = .052). Conclusions: Stent design influences periprocedural stroke or death in carotid stenting. Closed-cell stents are associated with a lower event rate when treating primary atherosclerosis, but not in the setting of restenosis.

Volume

70

Issue

1

First Page

e14

Last Page

e15

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