• World Neurosurg · Jul 2024

    Treatment results of carotid artery stenting with an open-cell stent: Analysis of 734 consecutive cases at a single center.

    • Yoshihiro Omura, Hirotoshi Imamura, Shoichi Tani, Hidemitsu Adachi, Manabu Sakaguchi, Kenichi Todo, Hiroshi Yamagami, Masanori Goto, Nobuyuki Ohara, Ryu Fukumitsu, Tadashi Sunohara, Shirabe Matsumoto, Nobuyuki Fukui, Tatsumaru Fukuda, Tomoaki Akiyama, Tsuyoshi Ohta, Chiaki Sakai, and Nobuyuki Sakai.
    • Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan; Department of Neurosurgery, Tokyo Women's Medical University Hospital, Shinjuku, Tokyo, Japan. Electronic address: yoshihiro.omura.528@gmail.com.
    • World Neurosurg. 2024 Jul 1; 187: e453e459e453-e459.

    ObjectiveIn carotid artery stenting (CAS) for internal carotid artery stenosis, the stent is often selected according to the plaque properties and arterial tortuosity. In our institute, an open-cell stent is used as the first-line stent regardless of the characteristics of the lesion. This study was performed to examine the outcome of CAS with an open-cell stent as the real-world results.MethodsIn total, 811 CAS procedures using open-cell stents were performed for internal carotid artery stenosis from April 2002 to December 2019. Of these patients, we excluded those with hyperacute conditions for which CAS was performed within 3 days of onset, those in whom acute mechanical thrombectomy was performed simultaneously with CAS, and those with stenosis due to arterial dissection. Thus, 734 patients were retrospectively analyzed. Perioperative and long-term outcomes and risk factors for perioperative infarction were investigated.ResultsThe periprocedural stroke rate and mortality rate were 3.7% (27/734) and 0.4% (3/734), respectively. Low-echoic plaque was a significant risk factor for periprocedural stroke in both univariate (P < 0.03) and multivariate (odds ratio, 2.69; 95% confidence interval, 1.14-6.66; P = 0.02) analyses. Cerebral infarction and high grade restenosis were observed in 15 (2.0%) and 17 (2.3%) patients during a median 50-month follow-up.ConclusionsCAS with open-cell stents showed good results in terms of both the postoperative stroke incidence and long-term severe restenosis rate. However, low-echoic plaque was a risk factor for perioperative stroke incidence, which should be considered when deciding on the indication for CAS with an open-cell stent.Copyright © 2024 Elsevier Inc. All rights reserved.

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