Comparing the embolic potential of open and closed cell stents during carotid angioplasty and stenting

Objective: We sought to determine the effects of open (O) and closed (C) cell stents on the size and number of embolic particles generated during carotid artery stenting (CAS) and assess the impact on outcome. Methods: Embolic debris from carotid filters after CAS was analyzed using photomicroscopy and imaging software. Patient comorbidities, preoperative cerebrovascular symptoms, stent type, and outcomes (perioperative major adverse events) were examined. Results: Carotid filters from 173 consecutive CAS procedures (O, 125 and C, 48) were reviewed. The mean age was 70.9 +/- 9.2 years; 58% were men. Mean stenosis was 88.2% +/- 8.1%; 36.6% had neurological symptoms preprocedurally. There was no difference in preoperative symptoms between the two groups (O, 38.7% vs C, 31.3%; P = not significant [NS]). However, closed cell stent use was associated with higher degree of stenosis (O, 87.2% +/- 8.0% vs C, 90.6% +/- 7.8%; P = .01), an older age (O, 70.0 +/- 8.6 years vs C, 73.4 +/- 10.2 years; P = .03), and peripheral arterial disease (21.1% vs 43.5%; P = .01). A larger mean particle size was observed in patients treated with open cell stents compared to closed cell stents (O, 416.5 +/- 335.7 mu m vs C, 301.1 +/- 251.3 mu m; P = .03). There was no significant difference in the total number of particles (O, 13.8 +/- 21.5 vs C, 17.6 +/- 19.9; P = NS), periprocedural stroke (P = NS), and major adverse events between the two groups (P = NS). Conclusions: Open cell stents are associated with a larger mean particle size compared to closed cell stents. No impact on procedural outcomes based on stent type was observed. (J Vasc Surg 2012;56:89-95.)