Published Online
on January 31, 2008

A more recent version of this article appeared on March 1, 2008

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Submitted on July 16, 2007
Accepted on August 14, 2007

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; and 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.

^* To whom correspondence should be addressed. 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

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