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Öcal L, Küp A, Çelik M, Cerşit S, Keskin M, Havan N, Gürsoy MO, Şahin M, Eren H, Koyuncu A, Uslu A, Yılmaz F, Yazıcıoğlu MV, Türkmen MM. What should be the Optimal Carotid Stent Opening Rate Without Post-Dilation? J Stroke Cerebrovasc Dis 2020; 29:105155. [PMID: 32912494 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/25/2020] [Accepted: 07/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is not a widely accepted optimal rate of stent opening in patients underwent carotid artery stenting. In this study we evaluated the effect of carotid stent opening rate (CSOR) without performing post-dilation on in-hospital and long-term outcomes. METHODS A total of 825 patient patients underwent carotid artery stenting without post-dilation enrolled to the study. The patients divided into two groups according to their final CSOR (50% ≤ Post-stent deployment (SD) <80% and 80% ≤ Post-SD ≤ 100%). In-hospital and 3-year outcomes were compared between the groups. RESULTS During hospitalization, the rate of ipsilateral stroke, major stroke and transient ischemic attacks were similar between the groups (respectively; 6.2% vs. 4.1, P = 0.190; 1.5% vs. 1.8, P = 0.811; 1.5% vs. 1.9%, P = 0.683). The 3-year Kaplan-Meier overall survival rates for the first and second groups were 87.6% and 84.4%, respectively (log rank test P = 0.426). The 3-year Kaplan-Meier overall cumulative ipsilateral stroke rates for the first and second groups were 88.0% and 88.6%, respectively (log rank test P = 0.409) CONCLUSION: Our study demonstrated that a CSOR higher than 50% without performing a post-dilation might be an effective therapeutic approach since there was not a significant difference regarding outcomes between the patients with a 50% ≤ Post-SD <80% and 80% ≤ Post-SD ≤ 100%. The need for post-stent balloon dilation might have been eliminated due to subsequent stent self-expansion.
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Affiliation(s)
- Lütfi Öcal
- Cardiology, Health Sciences University, Kartal Koşuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Ayhan Küp
- Cardiology, Health Sciences University, Kartal Koşuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Çelik
- Cardiology, Health Sciences University, Kartal Koşuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Sinan Cerşit
- Cardiology, Health Sciences University, Kartal Koşuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Muhammed Keskin
- Cardiology, Health Sciences University, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey.
| | - Nuri Havan
- Radiology, Health Sciences University, Kartal Koşuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Ozan Gürsoy
- Cardiology, Katip Çelebi University, Atatürk Training and Research Hospital, Izmir, Turkey
| | - Müslüm Şahin
- Cardiology, VM Pendik Medical Park Hospital, Istanbul, Turkey
| | - Hayati Eren
- Cardiology, Elbistan State Hospital, Kahramanmaraş, Turkey
| | - Atilla Koyuncu
- Cardiology, Health Sciences University, Bakırköy Training and Research Hospital, Istanbul, Turkey
| | - Abdulkadir Uslu
- Cardiology, Health Sciences University, Kartal Koşuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Fatih Yılmaz
- Cardiology, Health Sciences University, Kartal Koşuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Vefik Yazıcıoğlu
- Cardiology, Health Sciences University, Kartal Koşuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Muhsin Türkmen
- Cardiology, Health Sciences University, Kartal Koşuyolu Heart Training and Research Hospital, Istanbul, Turkey
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Texakalidis P, Giannopoulos S, Kokkinidis DG, Lanzino G. Effect of Open- vs Closed-Cell Stent Design on Periprocedural Outcomes and Restenosis After Carotid Artery Stenting: A Systematic Review and Comprehensive Meta-analysis. J Endovasc Ther 2018; 25:523-533. [DOI: 10.1177/1526602818783505] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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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Affiliation(s)
- Pavlos Texakalidis
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Aristotle University of Thessaloniki, Greece
| | | | - Damianos G. Kokkinidis
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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