Clinical outcomes of carotid artery stenting with open- versus closed-cell stents

Background The stent type may be associated with adverse events in carotid artery stenting (CAS). This study aimed to compare the clinical outcomes (stroke/myocardial infarction (MI)/death) of CAS with open- and closed-cell stents for patients with carotid artery stenosis.Methods Between April 2012 and May 2024, the clinical data of 223 patients who underwent CAS in our center were retrospectively analyzed. In terms of the stent type used, patients were divided into a closed-cell stent group and an open-cell stent group. Clinical outcomes between the two groups were compared. Univariate and multivariate analyses were performed to identify the independent risk factors. Subgroup analyses in terms of carotid plaque types and smoking history were conducted in carotid artery stenosis patients receiving CAS with open- and closed-cell stents.Results The combined in-hospital stroke/MI/death rate was significantly lower in the closed-cell stent group than in the open-cell stent group (p=0.026). Open-cell stents, smoking, and unstable plaques were the independent risk factors associated with a higher in-hospital stroke/MI/death rate. Subgroup analyses showed that for patients with unstable plaques, the combined in-hospital stroke/MI/death rate was significantly higher in the open-cell stent group than in the closed-cell stent group (p=0.016). For patients who smoked, the combined in-hospital stroke/MI/death rate was significantly higher in the open-cell stent group than in the closed-cell stent group (p=0.038).Conclusion For carotid artery stenosis patients with unstable carotid plaques or smoking history, using closed-cell stents in CAS may help reduce the combined in-hospital stroke/MI/death rate.