![]() ![]() Although controversial, there are data suggesting that stents with the lowest stent cell area are at lower risk of postprocedure stroke. Theoretically, an open cell stent has a higher chance of atheromatic plaque material extruding into the arterial lumen. Minor strokes following CAS are related to embolic material extruding through the stent architecture and subsequent embolization. Thirteen of 16 minor strokes, however, occurred within 24 hours of the CAS procedure. No major strokes occurred in the postprocedure period. In a study by Cao and coworkers in which they reviewed 505 CAS procedures, all but one major stroke occurred during catheterization of the target vessel or crossing the lesion with the embolic protection device (EPD). Closed cell stents have a lower cell area compared with open cell stents and may provide better coverage of the atherosclerotic lesion ( Fig. Postprocedure stroke severity and timing during CAS may be related to stent design. The higher radial force of the closed cell XACT stent may be more resistant to compressive forces at the bifurcation when compared with open cell nitinol stents and may be beneficial in limiting residual stenosis. However, in certain critically stenotic lesions, especially in the presence of calcification of the carotid bifurcation, residual carotid stenosis can be a problem. Residual stenosis following stent placement can usually be successfully treated with poststent balloon angioplasty. In general, the open cell stents such as the PRECISE (Cordis, Hialeah, FL) and ACCULINK (Abbott Laboratories, Chicago, IL) are more flexible than the closed cell XACT stent and may cross tortuous aortic arch–carotid anatomy, which the XACT (Abbott Laboratories, Chicago, IL) may not successfully track despite the use of stiffer embolic protection delivery wires. ![]() The flexibility of the stent can be an important determinant in successfully negotiating tortuous vessels. Inability to cross the carotid stenosis has multiple etiologies that include tortuous artic arch and a tortuous common carotid artery. Late complications include stent fracture and/or deformation, restenosis, and late stroke. Periprocedural complications include inability to cross the lesion with the stent, severe residual stenosis, and postprocedure stroke. This chapter focuses on clinical evidence describing the complications as well as the clinical decision making and preoperative evaluation to limit these complications.Ĭomplications following CAS with closed and open cell nitinol stents can be divided into periprocedural and late. There are certain complications that are more frequent or specific to the use of closed versus open cell nitinol carotid artery stents. Multiple prospective randomized controlled trials have compared carotid endarterectomy (CEA) with carotid artery stenting (CAS) and have shown comparable outcomes in asymptomatic patients. What is coronary artery disease? A Mayo Clinic cardiologist explains.The use of carotid artery stenting to treat carotid bifurcation stenosis remains a topic of recent investigation and vigorous debate regarding safety and efficacy.Coronary artery disease: Angioplasty or bypass surgery?.Calcium supplements: A risk factor for heart attack?.Angina treatment: Stents, drugs, lifestyle changes - What's best?.Drug-eluting or bare-metal stents for percutaneous coronary intervention: A systematic review and individual patient data meta-analysis of randomised clinical trials. The current literature on bioabsorbable stents: A review. Anti-platelet therapy for coronary stents. Journal of the American Heart Association. Drug-eluting or bare metal stents for left anterior descending or left main coronary artery revascularization. Drug-coated balloon versus drug-eluting stent in de novo small coronary vessel disease: A systematic review and meta-analysis. National Heart, Lung, and Blood Institute. Long-term efficacy of extended dual antiplatelet therapy after left main coronary artery bifurcation stenting. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. Drug eluting intracoronary stents: Stent types. ![]()
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