Comparison of Restenosis and Reintervention Rates in Closed Cell Stents Compared to Open Cell Stents After Carotid Artery Stenting.

Abstract

Objective: To compare short- and mid-term outcomes after carotid artery stenting (CAS) related to stent configuration.

Methods: This is a retrospective study of all CAS including transcarotid and transfemoral approaches, performed at our institution from 2015 to 2024. Groups were identified according to the stent used at the index procedure by open-cell stents (OCS) and closed-cell stents (CCS). Subgroup analysis by symptomatic status was also performed. Stroke, myocardial infarction (MI), and death were analyzed including those occurring within 30 days of procedure and on last follow-up (14.5±15.1 months). Restenosis and need for re-intervention were also assessed.

Results: Two-hundred and forty-six patients were included in our study cohort, with 128 OCS (Enroute stent [Silkroad Medical, Sunnyvale, CA]=76; Protégé stent [Medtronic, Minneapolis, MN]=34; Precise stent [Cordis, Miami Lakes, FL]=15; Acculink stent [Abbott, Abbott Park, IL]=3), and 118 CCS (Wallstent [Boston Scientific, Marlborough, MA]=118). Baseline characteristics and comorbidities of the overall cohort showed differences in BMI (CCS: 28.57±6.19, OCS: 29.79±5.98; p=0.018) and symptomatic status (CCS: 78, 66.1%, OCS: 34, 26.6%; p<0.001). In subgroup analysis within symptomatic and asymptomatic patients, these differences did not persist. Of note, in symptomatic patients, a higher rate of diabetics received CCS (33.3%) compared to OCS (14.7%, p=0.043). Composite outcomes of stroke, MI and death were no different at 30-days and on mid-term follow-up (14.5±15.1 months). Only MI at follow-up in the overall cohort was significantly higher in the OCS group (4.7%) compared to CCS (0%; p=0.03); however, this difference did not persist in subgroup analysis among symptomatic and asymptomatic patients. Restenosis (CCS: 16, 13.6%, OCS: 2, 1.6%; p<0.001) and re-interventions (CCS: 13, 11%, OCS: 0, 0%; p<0.001) were higher in the CCS group. Furthermore, this difference persisted for both outcomes in symptomatic and asymptomatic subgroup analysis. Multivariate analysis showed increased risk for restenosis in CCS (adjusted hazard ratio: 10.28, 95% Confidence Interval: 2.25-47.09; p=0.003).

Conclusion: No difference in short- and mid-term outcomes was present in either CCS or OCS regarding stroke, MI, or death. On mid-term follow-up, CCS patients had a higher rate of restenosis and re-intervention, and this difference persisted in both symptomatic and asymptomatic subgroups.