Section of Vascular and Endovascular Surgery (F.S., M.P., E.F., E.C.C., F.G., M.A.), Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Italy.
Section of Cardio Thoracic and Vascular Pathology (A.A., M.F.), Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Italy.
Stroke. 2023 Oct;54(10):2534-2541. doi: 10.1161/STROKEAHA.123.043117. Epub 2023 Aug 18.
The carotid stent design may influence the risk of embolization during carotid artery stenting. The aim of the study was to assess this risk by comparing the quantity of embolized material captured by filters during carotid artery stenting, using different stent designs.
We conducted a single-center retrospective study of patients undergoing carotid artery stenting for asymptomatic carotid stenosis >70% (2010-2022) in a tertiary academic hospital (Padua University Hospital, Italy). Carotid stents were classified according to their design as open-cell (OCS), closed-cell (CCS), or micromesh stents (MMS). A distal filter protection was used in all patients, and the amount of captured embolized particles was semiautomatically analyzed using a dedicated software (Image-Pro Plus, Media Cybernetics). Primary end point was embolic filter debris (EFD) load, defined as the ratio of the filter area covered by particulate material to the total filter area. Secondary end points were 30 days major stroke and death.
Four-hundred-eighty-one carotid artery stentings were included; 171 (35%) using an OCS, 68 (14%) a CCS, and 242 (50%) a MMS. Thirty-days mortality was 0.2% (n=1) and major stroke rate was 0.2% (=0.987). Filters of patients receiving MMS were more likely to be free from embolized material (OCS, 30%; CCS, 13%; MMS, 41%; <0.001) and had a lower EFD load (OCS, 9.1±14.5%; CCS, 7.9±14.0%; MMS, 5.0±9.1%; <0.001) compared with other stent designs. After stratification by plaque characteristics, MMS had a lower EFD load in cases of hypoechogenic plaque (OCS, 13.4±9.9%; CCS, 10.9±8.7%; MMS, 6.5±13.1%; <0.001), plaque length>15 mm (OC, 10.2±15.3; CC, 8.6±12.4; MM, 8.2±13.6; <0.001), and preoperative ipsilateral asymptomatic ischemic cerebral lesion (OCS, 12.9±16.8%; CCS, 8.7±19.5%; MMS, 5.4±9.7%; <0.001). After multivariate linear regression, use of MMS was associated with lower EFD load (=0.038).
The use of MMS seems to be associated with a lower embolization rate and EFD load, especially in hypoechogenic and long plaques and in patients with a preoperative evidence of asymptomatic ischemic cerebral lesion.
颈动脉支架的设计可能会影响颈动脉支架置入术中的栓塞风险。本研究旨在通过比较不同支架设计在颈动脉支架置入术中使用的过滤器捕获的栓塞材料的数量来评估这种风险。
我们进行了一项单中心回顾性研究，纳入了在意大利帕多瓦大学医院（Padua University Hospital）因无症状性颈动脉狭窄>70%（2010-2022 年）而行颈动脉支架置入术的患者。根据支架设计将颈动脉支架分为开腔（OCS）、闭腔（CCS）或微孔支架（MMS）。所有患者均使用远端滤器保护，使用专用软件（Image-Pro Plus，Media Cybernetics）半自动分析捕获的栓塞颗粒的数量。主要终点是栓塞滤器碎片（EFD）负荷，定义为颗粒物质覆盖的滤器面积与总滤器面积的比值。次要终点是 30 天主要卒中与死亡。
共纳入 481 例颈动脉支架置入术，其中 171 例（35%）使用 OCS，68 例（14%）使用 CCS，242 例（50%）使用 MMS。30 天死亡率为 0.2%（n=1），主要卒中发生率为 0.2%（n=0.987）。接受 MMS 治疗的患者的过滤器更有可能没有栓塞物质（OCS，30%；CCS，13%；MMS，41%；<0.001），EFD 负荷也更低（OCS，9.1±14.5%；CCS，7.9±14.0%；MMS，5.0±9.1%；<0.001），与其他支架设计相比。根据斑块特征进行分层后，在低回声斑块（OCS，13.4±9.9%；CCS，10.9±8.7%；MMS，6.5±13.1%；<0.001）、斑块长度>15mm（OC，10.2±15.3；CC，8.6±12.4；MM，8.2±13.6；<0.001）和术前同侧无症状性缺血性脑病变（OCS，12.9±16.8%；CCS，8.7±19.5%；MMS，5.4±9.7%；<0.001）患者中，MMS 的 EFD 负荷更低。多变量线性回归分析显示，使用 MMS 与较低的 EFD 负荷相关（=0.038）。
与其他支架设计相比，使用 MMS 似乎与较低的栓塞率和 EFD 负荷相关，尤其是在低回声和长斑块患者以及术前存在无症状性缺血性脑病变的患者中。
