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(Stroke. 2008;39:905.)
© 2008 American Heart Association, Inc.

Original Contributions

Does Carotid Stent Cell Design Matter?

Martin Schillinger, MD; Manfred Gschwendtner, MD; Bernhard Reimers, MD; Johannes Trenkler, MD; Luc Stockx, MD; Johann Mair, MD; Sumaira Macdonald, MD; Franz Karnel, MD; Kurt Huber, MD Erich Minar, MD

From the Department of Angiology (M.S., E.M.), Medical University, and the Third Medical Department (M.S., K.H.), Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria; the Department of Radiology (M.G.), Hospital Elisabethinen, Linz, Austria; the Department of Cardiology (B.R.), Hospital Mirano, Mirano, Italy; the Department of Radiology (J.T.), Wagner-Jauregg Hospital, Linz, Austria; the Department of Radiology (L.S.), Genk University Hospital, Genk, Belgium; the Department of Radiology (J.M.), Hospital Barmherzige Schwestern, Linz, Austria; the Department of Radiology (S.M.), Freeman Hospital, Newcastle-upon-Tyne, England; and the Department of Radiology (F.K.), Hospital SMZ-Sued, Vienna, Austria.

Correspondence to Martin Schillinger, MD, Department of Internal Medicine II, Division of Angiology, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. E-mail martin.schillinger{at}meduniwien.ac.at

Background and Purpose— Carotid stent cell design has recently been suggested to be a determinant of periprocedural and early postprocedural neurologic complications. We investigated the impact of closed- versus open-cell stent design on neurologic adverse events and mortality after carotid artery stenting.

Methods— We studied 1684 consecutive patients (1010 asymptomatic, 674 symptomatic) from 10 European centers who underwent carotid artery stenting with either closed-cell (n=859, 51%) or open-cell (n=825, 49%) design stents. Rates of transient ischemic attack, stroke, and death on the day of the procedure (acute events) and from day 1 to day 30 after the procedure (subacute events) were analyzed (95% CIs).

Results— Combined transient ischemic attack, stroke, or death rates, and stroke or death rates within 30 days of treatment were 6.1% (95% CI, 5.0 to 7.2) and 3.1% (95% CI, 2.3 to 3.9) for the closed-cell design versus 4.1% (95% CI, 3.2 to 5.0) and 2.4% (95% CI, 1.7 to 3.1) for the open-cell design stents (P=0.077, P=0.38), respectively, without significant differences in asymptomatic and symptomatic patients. By propensity-score–adjusted multivariable analysis, the open-cell carotid stent design was not associated with a differential risk for combined acute and subacute neurologic complications compared with closed-cell stents (adjusted odds ratio=0.84, P=0.53). When analyzed separately, the risk for acute events on the day of the procedure (adjusted odds ratio=0.83, P=0.57) and the risk for subacute events at days 1 to 30 (adjusted odds ratio=1.61, P=0.51) also were not significantly different between the groups.

Conclusions— Current data do not support the superiority of a specific carotid stent cell design with respect to neurologic complications, stroke, and mortality risk.

Key Words: stents • carotid artery