Stent Type and Risk of Late Cerebral Events After Carotid Artery Stenting

We read with great interest the recent paper by Gensicke et al. (1), which reported a 3-fold increased risk of recurrence of stroke or transient ischemic attack at 6 months in symptomatic patients treated with carotid artery stenting (CAS) and who showed new silent ischemic cerebral lesions on diffusion-weighted magnetic resonance imaging after the endovascular procedure. This observation did not apply to patients treated with carotid endoatherectomy (CEA). The investigators discussed the possible role of vulnerable plaques and the potential benefits of longer and more aggressive antiplatelet therapy. The study provided highly valuable new scientific evidence that might improve the current clinical outcomes of CAS and generated a hypothesis that deserves intensive investigation. However, the previously published ICSS (International Carotid Stenting Study) data provided little information on the kind of stent that was used (2). With cerebral protection, plaque coverage is a critical issue for CAS success; although CEA could remove almost the entire plaque, carotid stents have a free area between the struts where plaque prolapse could happen, with a risk of late embolization (3). It is well known that the free area surface varies according to stent design, with significant differences between open- and closed-cell stents; the latter has better plaque coverage and a lower incidence of plaque prolapse (4). Since the ICSS study was performed, new mesh-covered stents with a small...

Source: Journal of the American College of Cardiology - July 20, 2015 Category: Cardiology Source Type: research