The Effect of Stent Design on Plaque Protrusion after Carotid Artery Stenting

OBJECTIVE: The association between stent design and post-stent intravascular findings after carotid artery stenting (CAS) was evaluated. METHODS: Among the 79 patients who underwent CAS between March 2016 and June 2020 at our institution, we retrospectively analyzed 65 patients with full post-stent intravascular evaluation by both optical frequency domain imaging and angioscopy. All CAS procedures were performed under the flow reversal method, and the stent selection was determined by each operator’s discretion, depending on the vessel anatomy or plaque characteristics. The patient’s characteristics, plaque characteristics, ischemic complication, and post-stent intravascular findings (plaque protrusion, vessel wall apposition of stent) were compared between the closed-cell and open-cell stent groups. RESULTS: The closed-cell group (n = 34) had more high-risk plaques, such as symptomatic lesions or intraplaque hemorrhages, on MRI compared with the open-cell group (n = 31). There was no difference in the rate of ischemic complications between the groups. Although there was no difference in the frequency of plaque protrusion between the two, the maximum height of the protruded plaque was higher in the open-cell group (320 vs. 612 μm, p = 0.003) and incomplete apposition was higher in the closed-cell group (85.3 vs. 6.5%, p <0.0001). CONCLUSION: The open-cell stent provided better apposition but had larger plaque protrusion. The need for a new hybrid stent that combines the merits of both open- and closed-cell stents was suggested.