Stent design affects periprocedural carotid stenting risk
MedWire News: Use of stents with an open- rather than closed-cell design increases periprocedural risk during carotid stenting, the Carotid Stenting Trialists' Collaboration reports.
The study of patients in three large randomized trials also shows that use of protective devices does not reduce patients' risk for stroke or death within 30 days of the procedure, Fritz Wodarg (University of Kiel, Germany) told attendees at the European Stroke Conference in Lisbon, Portugal.
He presented data on 1548 patients for whom the type of stent used and use of a protective device was known. The patients were drawn from three large randomized trials: the Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial; the Stent-supported Percutaneous Angioplasty of the Carotid artery versus Endarterectomy (SPACE) trial; and the International Carotid Stenting Study (ICSS).
An open-cell stent, where not all struts are interconnected leaving an open area larger than 5 mm2, was used in 38.3% of patients in these trials.
The risk for the primary outcome, of any stroke or death within 30 days of stenting, occurred in 10.1% of patients given an open-cell stent, compared with just 6.1% of those given a closed-cell stent.
This equated to a significantly increased risk ratio of 1.67 for the primary outcome, which persisted after accounting for age, type of qualifying event, and whether patients had a history of stroke.
Use of protection devices ranged from 26.7% in SPACE to 92.3% in EVA-3S. But the rate of the primary outcome did not differ according to whether such devices were used, at 7.9% with and 7.1% without use of a protection device.
"The results do not support the use of intra-arterial protection devices in carotid artery stenting," Wodarg concluded.
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By Eleanor McDermid