Stent Design, Restenosis and Recurrent Stroke After Carotid Artery Stenting in the International Carotid Stenting Study
- Müller, Mandy D. From the Department of Neurology and Stroke Center (M.D.M., S.T.E., P.A.L., L.H.B.)
- Gregson, John Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (J.G.)
- McCabe, Dominick J.H. Department of Clinical Neurosciences, Royal Free Campus (D.J.H.M.), UCL Institute of Neurology, London, United Kingdom.
- Nederkoorn, Paul J. Department of Neurology, Amsterdam University Medical Center, the Netherlands (P.J.N.)
- van der Worp, H. Bart Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (H.B.v.d.W.), University Medical Center Utrecht, Utrecht University, the Netherlands
- de Borst, Gert J. Department of Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht University, the Netherlands
- Cleveland, Trevor Sheffield Vascular Institute, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom (T.C.)
- Wolff, Thomas Department of Vascular Surgery (T.W.), University of Basel, Switzerland
- Engelter, Stefan T. University Hospital Basel and Neurorehabilitation Unit, University Center for Medicine of Aging and Rehabilitation Basel, Felix Platter Hospital (S.T.E.), University of Basel, Switzerland
- Lyrer, Philippe A. From the Department of Neurology and Stroke Center (M.D.M., S.T.E., P.A.L., L.H.B.)
- Brown, Martin M.
- Bonati, Leo H. Stroke Research Center, Department of Brain Repair and Rehabilitation (L.H.B.), UCL Institute of Neurology, London, United Kingdom.
Published in:
- Stroke. - Ovid Technologies (Wolters Kluwer Health). - 2019, vol. 50, no. 11, p. 3013-3020
English
Background and Purpose—
Open-cell carotid artery stents are associated with a higher peri-procedural stroke risk than closed-cell stents. However, the effect of stent design on long-term durability of carotid artery stenting (CAS) is unknown. We compared the medium- to long-term risk of restenosis and ipsilateral stroke between patients treated with open-cell stents versus closed-cell stents in the ICSS (International Carotid Stenting Study).
Methods—
Patients with symptomatic carotid stenosis were randomized to CAS or endarterectomy and followed with duplex ultrasound for a median of 4.0 years. We analyzed data from patients with completed CAS procedures, known stent design, and available ultrasound follow-up. The primary outcome, moderate or higher restenosis (≥50%) was defined as a peak systolic velocity of >1.3 m/s on ultrasound or occlusion of the treated internal carotid artery and analyzed with interval-censored models.
Results—
Eight hundred fifty-five patients were allocated to CAS. Seven hundred fourteen patients with completed CAS and known stent design were included in the current analysis. Of these, 352 were treated with open-cell and 362 with closed-cell stents. Moderate or higher restenosis occurred significantly less frequently in patients treated with open-cell (n=113) than closed-cell stents (n=154; 5-year risks were 35.5% versus 46.0%; unadjusted hazard ratio, 0.68; 95% CI, 0.53–0.88). There was no significant difference in the risk of severe restenosis (≥70%) after open-cell stenting (n=27) versus closed-cell stenting (n=43; 5-year risks, 8.6% versus 12.7%; unadjusted hazard ratio, 0.63; 95% CI, 0.37–1.05). The risk of ipsilateral stroke beyond 30 days after treatment was similar with open-cell and closed-cell stents (hazard ratio, 0.78; 95% CI, 0.35–1.75).
Conclusions—
Moderate or higher restenosis after CAS occurred less frequently in patients treated with open-cell stents than closed-cell stents. However, both stent designs were equally effective at preventing recurrent stroke during follow-up.
Clinical Trial Registration—
URL:
http://www.isrctn.com/
. Unique identifier: ISRCTN25337470.
URL:
. Unique identifier: ISRCTN25337470.
- Language
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- English
- Open access status
- green
- Identifiers
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- DOI 10.1161/strokeaha.118.024076
- ISSN 0039-2499
- Persistent URL
- https://sonar.ch/global/documents/231909
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