Closed- or Open-cell stents in Carotid Artery Stenting?

Closed- or Open-cell stents in
Carotid Artery Stenting?
Comparison of the outcome of octogenarian patients
according to the stent type.
Data from a multicentre registry
Nikas D1, Reimers B2, Iakovou I3, Sangiorgi G3, Corvaja N3, Schlueter M4,
Schofer J4, Colombo A4
1Cardiac
and Vascular Catheterization Laboratory, Ioannina Public Hospital, Ioannina, GREECE
and Vascular Catheterization Laboratory, Cardiology Department, Mirano, ITALY
3EMO, Centro Cuore Columbus, and San Raffaele Hospital, Milan, ITALY
4Centre for Cardiology and Vascular Intervention, Hamburg, GERMANY
2Cardiac
I, Dimitris Nikas, MD,
have nothing
to disclosure related to the current presentation
Stent design
SMART®, Cordis
Xact®, Abbott Vascular
Devices
Protege®, ev3
Acculink®, Guidant
Exponent®, Medtronic
Carotid WALLSTENT
Boston Scientific
Precise®, Cordis
Sinus Carotid® RX,
Optimed
Stent design
Radialforce in reference to stent length (N/cm)
(parallel comressed by 30%)
0.5
0.40
0.4
0.4
Force (N/cm)
0.3
0.3
0.2
0.2
0.10
0.12
0.11
0.1
0.1
0.0
Acculink
Nextstent
Precise
Xact
Stent design
Vessel conformation
NITINOL stent
Mesh-wire stent
Precise, Cordis
Carotid WALLSTENT
Boston Scientific
Stent design
Lesion coverage & scaffolding
Closed cell-mesh wire
Open cell-Nitinol
Stent design
10x
Courtery of Houdart, CIRSE 2005
Stent design
Lesion coverage & scaffolding
Baseline
Open-cell Nitinol Stent
Stent design
Vessel apposition
1
2
Carotid Wallstent
9.0 x 30 mm
3
Stent design
Does it really matters?
Hart et al. J Vasc Surg 2006;44:725-730
Stent design
Does it really matters?
Bosiers M et al. J Vasc Surg 2006
Stent design
Does it really matters?
Bosiers M et al. J Vasc Surg 2006
Stent design
Does it really matters?
Meta-analysis of
data from registries
coming from 10
centers in Europe
UK
Belgium
Austria
Italy
Schillinger et al. Stroke 2008;39:905-909
Stent design
Does it really matters?
Schillinger et al. Stroke 2008;39:905-909
Stent design
Does it really matters?
Schillinger et al. Stroke 2008;39:905-909
Stent design
Does it really matters?
Schillinger et al. Stroke 2008;39:905-909
Octogenarians in CAS
Jahn R et al. European Heart Journal 2007;28:370-375
Octogenarians in CAS
Jahn R et al. European Heart Journal 2007;28:370-375
Octogenarians in CAS
749 pts undergoing CAS separated in different categories of age – symptomatic 30.7% of pts
Lead – In Phase CREST trial
Hobson R et al. J Vasc Surg 2004;40:1106-1111
Octogenarians in CAS
Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte
(ALKK)
CAS Registry
2700 CAS procedures – 11.2 % performed in > 80 yrs pts
Jahn R et al. European Heart Journal 2007;28:370-375
Octogenarians in CAS
Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte
(ALKK)
CAS Registry
2700 CAS procedures – 11.2 % performed in > 80 yrs pts
Jahn R et al. European Heart Journal 2007;28:370-375
Octogenarians
perform a bit worst in
CAS ?
Closed – cell are
better than Open –
cell stents?
Does the stent type plays a role in the
outcome of octogenarian patients treated
with CAS ?
Stent design
Does it really matters in Octogenarian pts?
Comparison of the outcome of octogenarian patients according to the stent type.
Data from a multicentre registry
Retrospective analysis of
Italy Milano
Germany
815 CAS procedures (lesions treated)
753 pts
Mean age 70.0 ± 8.4
Italy Mirano
82 pts (10.9%) > 80 yrs
(86 lesions treated)
Stent design
Does it really matters in Octogenarian pts?
Demographic data of the pts analysis
Patients > 80yrs, n
82
Age, mean ± SD
82.6 ± 2.4
Male, n (%)
50 (60.9)
Current Smoker, n (%)
2 (2.4)
Non Smoker, n (%)
53 (64.6)
Ex Smoker, n (%)
27 (33.0)
Hypertension, n (%)
59 (71.9)
Diabetes, n (%)
10 (12.2)
Hyperlipidemia n (%)
47 (57.3)
Stent design
Does it really matters in Octogenarian pts?
Angiographic data
Lesions, n
Bulky echo-lucent
86
Symptomatic, n (%)
30 (34.9)
Eccentric, n (%)
54 (62.7)
Calcified , n (%)
29 (33.7)
Ulcerated, n (%)
37 (43.0)
Thrombus, n (%)
22 (25.6)
Restenosis CEA, n (%)
2 (2.3)
Open-cell stent, n (%)
24 (27.9)
Closed-cell stent, n (%)
62 (72.1)
Distal protection, n (%)
82 (95.3)
Proximal protection, n (%)
4 (4.7)
Ulcerated lesion
Stent design
Does it really matters?
Retrospective analysis of Octogenarian pts
treated with CAS
Asymptomatic
Symptomatic
Total
Open-cell
19
5
24
Closed-cell
35
23
58
Total
54
28
82
86 Stents placed in 82 patients
Stent design
Does it really matters in Octogenarian pts?
Stoke/Death event
N (%)
No event
N (%)
Total
N
2 (2.4)
80 (97.6)
82
2 (3.4)
56 (96.6)
58
2 (5.7)
33 (94.3)
35
0 (0)
23 (100)
23
Total
0 (0)
24 (100)
24
Asymptomatic
0 (0)
19 (100)
19
0 (0)
5(100)
5
CC stent
Total
Asymptomatic
Symptomatic
OC stent
Symptomatic
Death/stroke event @ 30 days post-procedure
Stent design
Does it really matters in Octogenarian pts?
P=0.16
6
5
5.7
4
P=0.77
%
CC
OC
3
2
2.4
1
0
Total
Asympt
Sympt
Death/stroke event @ 30 days post-procedure
Stent design
Conclusions
9Octogenarian
patients regard a significant proportion of patients
treated with Carotid Stenting.
9In
this small number of consecutive octogenarian patients who
underwent CAS, the usage of different stent design had NO impact in
their short-term outcome.
9Head-to-head
randomised comparison between stents of different
designs in matched patient population is needed to confirm these results.
But it’s almost impossible to be performed since it
requires a quite large number of patients enrolled!!!
Stent design
Conclusions
Neither the Open nor the Closed cell stents
are better one of the other....
...Zebras
...barcodes!
Stent design
Conclusions
They do share some similarities!