Effect of Open- vs Closed-Cell Stent Design on Periprocedural Outcomes and Restenosis After Carotid Artery Stenting

A Systematic Review and Comprehensive Meta-analysis

Pavlos Texakalidis, Stefanos Giannopoulos, Damianos G. Kokkinidis, Giuseppe Lanzino

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Purpose:To compare periprocedural complications and in-stent restenosis rates associated with open- vs closed-cell stent designs used in carotid artery stenting (CAS). Methods: A systematic search was conducted to identify all randomized and observational studies published in English up to October 31, 2017, that compared open- vs closed-cell stent designs in CAS. Identified studies were included if they reported the following outcomes: stroke, transient ischemic attack (TIA), myocardial infarction (MI), hemodynamic depression, new ischemic lesions detected on imaging, and death within 30 days, as well as the incidence of in-stent restenosis. A random-effects model meta-analysis was employed. Model results are reported as the odds ratio (OR) and 95% confidence interval (CI). The I2 statistic was used to assess heterogeneity. Results: Thirty-three studies (2 randomized trials) comprising 20 291 patients (mean age 71.3±3.0 years; 74.6% men) were included. Patients in the open-cell stent group had a statistically significant lower risk of restenosis ⩾40% (OR 0.42, 95% CI 0.19 to 0.92; I2=0%) and ⩾70% (OR 0.23, 95% CI 0.10 to 0.52; I2=0%) at a mean follow-up of 24 months. No statistically significant differences were identified for periprocedural stroke, TIA, new ischemic lesions, MI, hemodynamic depression, or death within 30 days after CAS. Sensitivity analysis of the 2 randomized controlled trials only did not point to any significant differences either. Conclusion: Use of open-cell stent design in CAS is associated with a decreased risk for restenosis when compared to the closed-cell stent, without significant differences in periprocedural outcomes.

Original languageEnglish (US)
JournalJournal of Endovascular Therapy
DOIs
StateAccepted/In press - Jun 1 2018

Fingerprint

Carotid Arteries
Stents
Meta-Analysis
Odds Ratio
Transient Ischemic Attack
Confidence Intervals
Hemodynamics
Stroke
Myocardial Infarction
Observational Studies
Randomized Controlled Trials
Incidence

Keywords

  • carotid artery stenting
  • closed-cell design
  • complications
  • in-stent restenosis
  • mortality
  • open-cell design
  • stenosis
  • stent
  • stroke

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Effect of Open- vs Closed-Cell Stent Design on Periprocedural Outcomes and Restenosis After Carotid Artery Stenting : A Systematic Review and Comprehensive Meta-analysis. / Texakalidis, Pavlos; Giannopoulos, Stefanos; Kokkinidis, Damianos G.; Lanzino, Giuseppe.

In: Journal of Endovascular Therapy, 01.06.2018.

Research output: Contribution to journalArticle

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abstract = "Purpose:To compare periprocedural complications and in-stent restenosis rates associated with open- vs closed-cell stent designs used in carotid artery stenting (CAS). Methods: A systematic search was conducted to identify all randomized and observational studies published in English up to October 31, 2017, that compared open- vs closed-cell stent designs in CAS. Identified studies were included if they reported the following outcomes: stroke, transient ischemic attack (TIA), myocardial infarction (MI), hemodynamic depression, new ischemic lesions detected on imaging, and death within 30 days, as well as the incidence of in-stent restenosis. A random-effects model meta-analysis was employed. Model results are reported as the odds ratio (OR) and 95{\%} confidence interval (CI). The I2 statistic was used to assess heterogeneity. Results: Thirty-three studies (2 randomized trials) comprising 20 291 patients (mean age 71.3±3.0 years; 74.6{\%} men) were included. Patients in the open-cell stent group had a statistically significant lower risk of restenosis ⩾40{\%} (OR 0.42, 95{\%} CI 0.19 to 0.92; I2=0{\%}) and ⩾70{\%} (OR 0.23, 95{\%} CI 0.10 to 0.52; I2=0{\%}) at a mean follow-up of 24 months. No statistically significant differences were identified for periprocedural stroke, TIA, new ischemic lesions, MI, hemodynamic depression, or death within 30 days after CAS. Sensitivity analysis of the 2 randomized controlled trials only did not point to any significant differences either. Conclusion: Use of open-cell stent design in CAS is associated with a decreased risk for restenosis when compared to the closed-cell stent, without significant differences in periprocedural outcomes.",
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AU - Lanzino, Giuseppe

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KW - stenosis

KW - stent

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