O-042 - DO NEW GENERATION STENTS IMPACT ON STROKE PREVENTION IN ASYMPTOMATIC PATIENTS UNDERGOING CAROTID ARTERY STENTING? A REAL-WORLD ANALYSIS OF A MULTICENTER 10-YEAR EXPERIENCE.

TOPIC:
Other
AUTHORS:
Desantis C. (Vascular and Endovascular Surgery - Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine ~ Bari ~ Italy) , Zacà S. (Vascular and Endovascular Surgery - Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine ~ Bari ~ Italy) , Petrone B. (Vascular and Endovascular Surgery - Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine ~ Bari ~ Italy) , Casciaro M. (Vascular and Endovascular Surgery - Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine ~ Bari ~ Italy) , De Michele V. (Vascular and Endovascular Surgery - Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine ~ Bari ~ Italy) , Palermo V. (Vascular Surgery - Department of Medicine and Surgery, University of Insubria School of Medicine ~ Varese ~ Italy) , Menna D. (Vascular Surgery Division - Cardiovascular Department, San Carlo Hospital ~ Potenza ~ Italy) , Fontana F. (Vascular Surgery - Department of Medicine and Surgery, University of Insubria School of Medicine ~ Varese ~ Italy) , Cappiello P. (Vascular Surgery Division - Cardiovascular Department, San Carlo Hospital ~ Potenza ~ Italy) , Esposito A. (Vascular Surgery Division - Cardiovascular Department, San Carlo Hospital ~ Potenza ~ Italy) , Piffaretti G. (Vascular Surgery - Department of Medicine and Surgery, University of Insubria School of Medicine ~ Varese ~ Italy) , Pulli R. (Vascular and Endovascular Surgery - University of Florence School of Medicine ~ Florence ~ Italy) , Angiletta D. (Vascular and Endovascular Surgery - Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine ~ Bari ~ Italy)
Introduction:
The design of new generation stents during carotid artery stenting (CAS) has been advocated as a crucial factor that may impact on stroke prevention. Data are controversial regarding the superiority of any specific stent design. The present study investigated the association between stent cell design and stroke prevention in asymptomatic patients affected by severe carotid artery stenosis in a multicenter registry.
Methods:
From January 2006 to January 2022, 781 transfemoral CAS procedures were performed in 769 patients (568 males, 71.4%) with an asymptomatic severe carotid stenosis (>70%) in three Italian tertiary referral centers. All the procedures were conducted with cerebral protection devices (CPDs). Patients were divided in two groups considering the cell stent design: an open cell stent (OC) was used in 492 procedures and in 287 CAS another type of cell stent (OS, other stents: closed cell, CC; hybrid, HC and double-layer,DL) was deployed. Preoperative data included demographics and comorbidities. Peri-operative details were: ipsilateral and contralateral carotid stenosis degree, type of stents, type of embolic protection devices (EPDs). Post-operative data included: technical success, access-site and systemic complications and type of antiplatelet medication drugs. 30-day outcomes were stroke, all cause death, stroke/death and myocardial infarction. Follow-up outcomes were evaluated at 10 years. Primary follow-up outcomes included: survival, stroke (ipsilateral and contralateral) and stroke related mortality rates. Secondary follow-up outcomes were: freedom from restenosis and reintervention rates. Data were analyzed using the χ2 test and Fisher's exact test while follow-up outcomes were investigated with life-table Kaplan-Meier curves. The log-rank test was used to determine differences between the groups and univariate analysis was employed to identify the association between risk factors and stroke rates. P<0.05 was considered significant.
Results:
781 procedures were performed (OC: 61.8%, OS: 36.1%), 24 were bilateral (3%). Mean age was 72.5±8.2 years (OC, 72.5±7.8; F, 72.6±8.8). In 2 patients the technical success was not achieved (0.2%) thus 779 patients were finally analyzed. 30-day outcomes: stroke rate was 2.3% (OC: 1.4%; OS: 3.8%; p=.031), mortality rate was 0.3% (OC: 0.4%; p=.279), stroke/death rate was 2.6% (OC: 1.8%; OS: 3.8% p=.089) and no cardiac events (MI) were recorded. 664 CAS were followed-up with a mean of 60.3±39.6 months (range: 1-176 months). 10-year follow-up outcomes: overall survival rate was 45.1% (OC: 45.4%; OS: 54.5%; log-rank 2, p=.153), the overall stroke rate was 5% (OC: 3.9%; OS: 4.1%, log-rank 6.9, p=.008) and 3.5% were ipsilateral (OC: 1.9%; OS: 2.5%, log-rank 4.3, p=.036), stroke-related mortality rate was 3.5% (OC: 3.4%; OS: 1.5%, log-rank 0.3, p=.555). Overall freedom from restenosis rate was 88.6% (OC: 89.9%; OS: 83.6%; log-rank 1, p=.302) and overall reintervention rate was 4.1% (OC: 4.1%; OS:4.2%; log-rank 0.004, p=.952). At 2.5 years Kaplan-Meier curves showed a statistically significant increment of overall and ipsilateral stroke rates when closed cell or hybrid stents were used compared to open cell and double layer stents (log-rank 10.6, p=.014). At 10-year follow-up no stroke events were recorded in the double layer stent group, while open cell stents showed a stroke rate of 1.9%. The univariate analysis demonstrated that ipsilateral stroke rate was statistically influenced by peripheral artery disease (PAD, log-rank 5.1, p= .024) and stent type design (log-rank 4.3, p= .036).
Conclusion:
The design of open cell stents seems to be the most favorable in terms of prevention of periprocedural stroke in asymptomatic patients underwent CAS. Closed and hybrid cell stents showed higher rates of stroke (overall and ipsilateral) compared with open cell stents and double layer stents at 2.5-year follow-up. New generation double layer stents performed better compared with any other type of stent in terms of 10-year stroke prevention.