The effect of kinking and residual plaque ulcers after carotid artery stenting: differences between closed stent design and double-layer stents.

IF 1.8 4区医学 Q3 PERIPHERAL VASCULAR DISEASE

International Angiology Pub Date : 2025-10-01 DOI:10.23736/S0392-9590.25.05477-X

Carmine Poliseno, Rodolfo Pini, Marcello Lodato, Enrico Gallitto, Betti Shyti, Andrea Vacirca, Mauro Gargiulo, Gianluca Faggioli

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引用次数: 0

Abstract

Background: Carotid stenting (CAS) is an established alternative to carotid endarterectomy for asymptomatic and symptomatic stenosis. However, morphological features possibly appearing after CAS, such as carotid tortuosity/kinking and plaque ulcers underneath the stent (PuUS) remain under investigated. This study evaluates the impact of these factors on postoperative neurological risks, according to the type of stent implanted, i.e. closed stent design (CSD) versus double-layer stents (DLS).

Methods: A single center retrospective evaluation of all consecutive CAS from 2004 to 2022 was performed. Cerebral protection filters devices were routinely employed, and traditional CSD (Wallstents, Boston Scientific, Natick, MA, USA) until 2015, followed by DLSs (Roadsaver, Terumo Corp., Tokyo, Japan). Stroke rates at 30 days and 1 year were assessed, focusing on stent-determined carotid kinking (angle >90°) and the presence of residual plaque ulcers underneath the deployed stent.

Results: A total of 644 CAS patients (27% symptomatic) were analyzed. The procedure achieved a technical success rate of 96%, with a significantly higher stroke rate in symptomatic compared to asymptomatic patients (5.8% vs. 2.1%, P=0.01). Post-stent carotid kinking (4.2%) and residual plaque ulcers (8.4%) were more frequent with DLS than CSD (P=0.04 and P=0.001). Residual ulcers increased 30-day stroke risk (13% vs. 2.2%, P<0.001) but not post-CAS kinking (2.7% vs. 3.1%, P=0.92). DLS showed no strokes with residual ulcers at 30 days and 1 year (P=0.0001 and P=0.03, respectively), differently from CSD (19%).

Conclusions: DLS are associated with a higher rate of stent determined distal internal carotid kinking and residual plaque ulcers but demonstrate a protective effect, minimizing stroke risk from plaque ulcers compared to CSD. These findings support the use of DLS to reduce cerebral embolization.

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颈动脉支架植入术后扭结和残留斑块溃疡的影响：封闭式支架设计与双层支架设计的差异

背景：颈动脉支架植入术（CAS）是一种替代颈动脉内膜切除术治疗无症状和症状性狭窄的方法。然而，CAS后可能出现的形态学特征，如颈动脉扭曲/扭结和支架下的斑块溃疡（PuUS）仍在研究中。本研究根据植入的支架类型，即封闭支架设计（CSD）与双层支架（DLS），评估这些因素对术后神经系统风险的影响。方法：对2004 ~ 2022年所有连续CAS进行单中心回顾性评价。常规使用脑保护过滤器装置和传统CSD （Wallstents, Boston Scientific, Natick， MA， USA）直到2015年，随后使用dls （Roadsaver, Terumo Corp, Tokyo, Japan）。评估30天和1年的卒中发生率，重点关注支架决定的颈动脉扭曲（角度>90°）和部署支架下残留斑块溃疡的存在。结果：共分析644例CAS患者（有症状者占27%）。该手术的技术成功率为96%，有症状患者的卒中发生率明显高于无症状患者（5.8%对2.1%，P=0.01）。支架后颈动脉扭曲（4.2%）和残留斑块溃疡（8.4%）在DLS患者中的发生率高于CSD患者（P=0.04和P=0.001）。残留溃疡增加30天卒中风险（13% vs. 2.2%）结论：与CSD相比，DLS与支架确定的颈动脉远端扭曲和残留斑块溃疡的发生率较高相关，但显示出保护作用，将斑块溃疡的卒中风险降至最低。这些发现支持使用DLS来减少脑栓塞。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Angiology 医学-外周血管病

CiteScore

2.80

自引率

28.60%

发文量

审稿时长

6-12 weeks

期刊介绍： International Angiology publishes scientific papers on angiology. Manuscripts may be submitted in the form of editorials, original articles, review articles, special articles, letters to the Editor and guidelines. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work. Duties and responsibilities of all the subjects involved in the editorial process are summarized at Publication ethics. Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors (ICMJE).