A meta-analysis of the effect of stent design on clinical and radiologic outcomes of carotid artery stenting

Evelien E. de Vries, Armelle J.A. Meershoek, Evert J. Vonken, Hester M. den Ruijter, Jos C. van den Berg, Gert J. de Borst*, K. Bijuklic, J. Schofer, L. Bonati, M. Bosiers, J. Wauters, G. de Donato, E. Chisci, C. Setacci, D. Doig, R. L. Featherstone, J. Dobson, M. M. Brown, M. K. Eskandari, J. GiriI. Q. Grunwald, A. L. Kühn, D. K. Han, P. L. Faries, F. Hernandez-Fernandez, G. Parrilla, M. Hornung, H. Sievert, K. Kono, P. Latacz, J. Ledwoch, H. Mudra, G. Maleux, R. Nolz, T. Ohki, M. Piazza, P. Pieniazek, L. Tekieli, D. Radak, S. Tanaskovic, M. Rasiova, G. Simonte, B. Fiorucci, M. W.K. Tietke, G. Ventoruzzo

*Corresponding author for this work

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Objective: Procedural characteristics, including stent design, may influence the outcome of carotid artery stenting (CAS). A thorough comparison of the effect of stent design on outcome of CAS is thus warranted to allow for optimal evidence-based clinical decision making. This study sought to evaluate the effect of stent design on clinical and radiologic outcomes of CAS. Methods: A systematic search was conducted in MEDLINE, Embase, and Cochrane databases in May 2018. Included were articles reporting on the occurrence of clinical short- and intermediate-term major adverse events (MAEs; any stroke or death) or radiologic adverse events (new ischemic lesions on postprocedural magnetic resonance diffusion-weighted imaging [MR-DWI], restenosis, or stent fracture) in different stent designs used to treat carotid artery stenosis. Random effects models were used to calculate combined overall effect sizes. Metaregression was performed to identify the effect of specific stents on MAE rates. Results: From 2654 unique identified articles, two randomized, controlled trials and 66 cohort studies were eligible for analysis (including 46,728 procedures). Short-term clinical MAE rates were similar for patients treated with open cell vs closed cell or hybrid stents. Use of an Acculink stent was associated with a higher risk of short-term MAE compared with a Wallstent (risk ratio [RR], 1.51; P = .03), as was true for use of Precise stent vs Xact stent (RR, 1.55; P < .001). Intermediate-term clinical MAE rates were similar for open vs closed cell stents. Use of open cell stents predisposed to a 25% higher chance (RR, 1.25; P = .03) of developing postprocedural new ischemic lesions on MR-DWI. No differences were observed in the incidence of restenosis, stent fracture, or intraprocedural hemodynamic depression with respect to different stent design. Conclusions: Stent design is not associated with short- or intermediate-term clinical MAE rates in patients undergoing CAS. Furthermore, the division in open and closed cell stent design might conceal true differences in single stent efficacy. Nevertheless, open cell stenting resulted in a significantly higher number of subclinical postprocedural new ischemic lesions detected on MR-DWI compared with closed cell stenting. An individualized patient data meta-analysis, including future studies with prospective homogenous study design, is required to adequately correct for known risk factors and to provide definite conclusions with respect to carotid stent design for specific subgroups.

Original languageEnglish (US)
Pages (from-to)1952-1961.e1
JournalJournal of Vascular Surgery
Volume69
Issue number6
DOIs
StatePublished - Jun 2019

Fingerprint

Carotid Arteries
Stents
Meta-Analysis
Diffusion Magnetic Resonance Imaging
Odds Ratio
Hybrid Cells
Carotid Stenosis
MEDLINE

Keywords

  • Carotid artery stenting
  • MR-DWI
  • Meta-analysis
  • Stent design
  • Stroke

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

de Vries, E. E., Meershoek, A. J. A., Vonken, E. J., den Ruijter, H. M., van den Berg, J. C., de Borst, G. J., ... Ventoruzzo, G. (2019). A meta-analysis of the effect of stent design on clinical and radiologic outcomes of carotid artery stenting. Journal of Vascular Surgery, 69(6), 1952-1961.e1. https://doi.org/10.1016/j.jvs.2018.11.017
de Vries, Evelien E. ; Meershoek, Armelle J.A. ; Vonken, Evert J. ; den Ruijter, Hester M. ; van den Berg, Jos C. ; de Borst, Gert J. ; Bijuklic, K. ; Schofer, J. ; Bonati, L. ; Bosiers, M. ; Wauters, J. ; de Donato, G. ; Chisci, E. ; Setacci, C. ; Doig, D. ; Featherstone, R. L. ; Dobson, J. ; Brown, M. M. ; Eskandari, M. K. ; Giri, J. ; Grunwald, I. Q. ; Kühn, A. L. ; Han, D. K. ; Faries, P. L. ; Hernandez-Fernandez, F. ; Parrilla, G. ; Hornung, M. ; Sievert, H. ; Kono, K. ; Latacz, P. ; Ledwoch, J. ; Mudra, H. ; Maleux, G. ; Nolz, R. ; Ohki, T. ; Piazza, M. ; Pieniazek, P. ; Tekieli, L. ; Radak, D. ; Tanaskovic, S. ; Rasiova, M. ; Simonte, G. ; Fiorucci, B. ; Tietke, M. W.K. ; Ventoruzzo, G. / A meta-analysis of the effect of stent design on clinical and radiologic outcomes of carotid artery stenting. In: Journal of Vascular Surgery. 2019 ; Vol. 69, No. 6. pp. 1952-1961.e1.
@article{f3b4982129134dde905577bb7cda95ed,
title = "A meta-analysis of the effect of stent design on clinical and radiologic outcomes of carotid artery stenting",
abstract = "Objective: Procedural characteristics, including stent design, may influence the outcome of carotid artery stenting (CAS). A thorough comparison of the effect of stent design on outcome of CAS is thus warranted to allow for optimal evidence-based clinical decision making. This study sought to evaluate the effect of stent design on clinical and radiologic outcomes of CAS. Methods: A systematic search was conducted in MEDLINE, Embase, and Cochrane databases in May 2018. Included were articles reporting on the occurrence of clinical short- and intermediate-term major adverse events (MAEs; any stroke or death) or radiologic adverse events (new ischemic lesions on postprocedural magnetic resonance diffusion-weighted imaging [MR-DWI], restenosis, or stent fracture) in different stent designs used to treat carotid artery stenosis. Random effects models were used to calculate combined overall effect sizes. Metaregression was performed to identify the effect of specific stents on MAE rates. Results: From 2654 unique identified articles, two randomized, controlled trials and 66 cohort studies were eligible for analysis (including 46,728 procedures). Short-term clinical MAE rates were similar for patients treated with open cell vs closed cell or hybrid stents. Use of an Acculink stent was associated with a higher risk of short-term MAE compared with a Wallstent (risk ratio [RR], 1.51; P = .03), as was true for use of Precise stent vs Xact stent (RR, 1.55; P < .001). Intermediate-term clinical MAE rates were similar for open vs closed cell stents. Use of open cell stents predisposed to a 25{\%} higher chance (RR, 1.25; P = .03) of developing postprocedural new ischemic lesions on MR-DWI. No differences were observed in the incidence of restenosis, stent fracture, or intraprocedural hemodynamic depression with respect to different stent design. Conclusions: Stent design is not associated with short- or intermediate-term clinical MAE rates in patients undergoing CAS. Furthermore, the division in open and closed cell stent design might conceal true differences in single stent efficacy. Nevertheless, open cell stenting resulted in a significantly higher number of subclinical postprocedural new ischemic lesions detected on MR-DWI compared with closed cell stenting. An individualized patient data meta-analysis, including future studies with prospective homogenous study design, is required to adequately correct for known risk factors and to provide definite conclusions with respect to carotid stent design for specific subgroups.",
keywords = "Carotid artery stenting, MR-DWI, Meta-analysis, Stent design, Stroke",
author = "{de Vries}, {Evelien E.} and Meershoek, {Armelle J.A.} and Vonken, {Evert J.} and {den Ruijter}, {Hester M.} and {van den Berg}, {Jos C.} and {de Borst}, {Gert J.} and K. Bijuklic and J. Schofer and L. Bonati and M. Bosiers and J. Wauters and {de Donato}, G. and E. Chisci and C. Setacci and D. Doig and Featherstone, {R. L.} and J. Dobson and Brown, {M. M.} and Eskandari, {M. K.} and J. Giri and Grunwald, {I. Q.} and K{\"u}hn, {A. L.} and Han, {D. K.} and Faries, {P. L.} and F. Hernandez-Fernandez and G. Parrilla and M. Hornung and H. Sievert and K. Kono and P. Latacz and J. Ledwoch and H. Mudra and G. Maleux and R. Nolz and T. Ohki and M. Piazza and P. Pieniazek and L. Tekieli and D. Radak and S. Tanaskovic and M. Rasiova and G. Simonte and B. Fiorucci and Tietke, {M. W.K.} and G. Ventoruzzo",
year = "2019",
month = "6",
doi = "10.1016/j.jvs.2018.11.017",
language = "English (US)",
volume = "69",
pages = "1952--1961.e1",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "6",

}

de Vries, EE, Meershoek, AJA, Vonken, EJ, den Ruijter, HM, van den Berg, JC, de Borst, GJ, Bijuklic, K, Schofer, J, Bonati, L, Bosiers, M, Wauters, J, de Donato, G, Chisci, E, Setacci, C, Doig, D, Featherstone, RL, Dobson, J, Brown, MM, Eskandari, MK, Giri, J, Grunwald, IQ, Kühn, AL, Han, DK, Faries, PL, Hernandez-Fernandez, F, Parrilla, G, Hornung, M, Sievert, H, Kono, K, Latacz, P, Ledwoch, J, Mudra, H, Maleux, G, Nolz, R, Ohki, T, Piazza, M, Pieniazek, P, Tekieli, L, Radak, D, Tanaskovic, S, Rasiova, M, Simonte, G, Fiorucci, B, Tietke, MWK & Ventoruzzo, G 2019, 'A meta-analysis of the effect of stent design on clinical and radiologic outcomes of carotid artery stenting', Journal of Vascular Surgery, vol. 69, no. 6, pp. 1952-1961.e1. https://doi.org/10.1016/j.jvs.2018.11.017

A meta-analysis of the effect of stent design on clinical and radiologic outcomes of carotid artery stenting. / de Vries, Evelien E.; Meershoek, Armelle J.A.; Vonken, Evert J.; den Ruijter, Hester M.; van den Berg, Jos C.; de Borst, Gert J.; Bijuklic, K.; Schofer, J.; Bonati, L.; Bosiers, M.; Wauters, J.; de Donato, G.; Chisci, E.; Setacci, C.; Doig, D.; Featherstone, R. L.; Dobson, J.; Brown, M. M.; Eskandari, M. K.; Giri, J.; Grunwald, I. Q.; Kühn, A. L.; Han, D. K.; Faries, P. L.; Hernandez-Fernandez, F.; Parrilla, G.; Hornung, M.; Sievert, H.; Kono, K.; Latacz, P.; Ledwoch, J.; Mudra, H.; Maleux, G.; Nolz, R.; Ohki, T.; Piazza, M.; Pieniazek, P.; Tekieli, L.; Radak, D.; Tanaskovic, S.; Rasiova, M.; Simonte, G.; Fiorucci, B.; Tietke, M. W.K.; Ventoruzzo, G.

In: Journal of Vascular Surgery, Vol. 69, No. 6, 06.2019, p. 1952-1961.e1.

Research output: Contribution to journalReview article

TY - JOUR

T1 - A meta-analysis of the effect of stent design on clinical and radiologic outcomes of carotid artery stenting

AU - de Vries, Evelien E.

AU - Meershoek, Armelle J.A.

AU - Vonken, Evert J.

AU - den Ruijter, Hester M.

AU - van den Berg, Jos C.

AU - de Borst, Gert J.

AU - Bijuklic, K.

AU - Schofer, J.

AU - Bonati, L.

AU - Bosiers, M.

AU - Wauters, J.

AU - de Donato, G.

AU - Chisci, E.

AU - Setacci, C.

AU - Doig, D.

AU - Featherstone, R. L.

AU - Dobson, J.

AU - Brown, M. M.

AU - Eskandari, M. K.

AU - Giri, J.

AU - Grunwald, I. Q.

AU - Kühn, A. L.

AU - Han, D. K.

AU - Faries, P. L.

AU - Hernandez-Fernandez, F.

AU - Parrilla, G.

AU - Hornung, M.

AU - Sievert, H.

AU - Kono, K.

AU - Latacz, P.

AU - Ledwoch, J.

AU - Mudra, H.

AU - Maleux, G.

AU - Nolz, R.

AU - Ohki, T.

AU - Piazza, M.

AU - Pieniazek, P.

AU - Tekieli, L.

AU - Radak, D.

AU - Tanaskovic, S.

AU - Rasiova, M.

AU - Simonte, G.

AU - Fiorucci, B.

AU - Tietke, M. W.K.

AU - Ventoruzzo, G.

PY - 2019/6

Y1 - 2019/6

N2 - Objective: Procedural characteristics, including stent design, may influence the outcome of carotid artery stenting (CAS). A thorough comparison of the effect of stent design on outcome of CAS is thus warranted to allow for optimal evidence-based clinical decision making. This study sought to evaluate the effect of stent design on clinical and radiologic outcomes of CAS. Methods: A systematic search was conducted in MEDLINE, Embase, and Cochrane databases in May 2018. Included were articles reporting on the occurrence of clinical short- and intermediate-term major adverse events (MAEs; any stroke or death) or radiologic adverse events (new ischemic lesions on postprocedural magnetic resonance diffusion-weighted imaging [MR-DWI], restenosis, or stent fracture) in different stent designs used to treat carotid artery stenosis. Random effects models were used to calculate combined overall effect sizes. Metaregression was performed to identify the effect of specific stents on MAE rates. Results: From 2654 unique identified articles, two randomized, controlled trials and 66 cohort studies were eligible for analysis (including 46,728 procedures). Short-term clinical MAE rates were similar for patients treated with open cell vs closed cell or hybrid stents. Use of an Acculink stent was associated with a higher risk of short-term MAE compared with a Wallstent (risk ratio [RR], 1.51; P = .03), as was true for use of Precise stent vs Xact stent (RR, 1.55; P < .001). Intermediate-term clinical MAE rates were similar for open vs closed cell stents. Use of open cell stents predisposed to a 25% higher chance (RR, 1.25; P = .03) of developing postprocedural new ischemic lesions on MR-DWI. No differences were observed in the incidence of restenosis, stent fracture, or intraprocedural hemodynamic depression with respect to different stent design. Conclusions: Stent design is not associated with short- or intermediate-term clinical MAE rates in patients undergoing CAS. Furthermore, the division in open and closed cell stent design might conceal true differences in single stent efficacy. Nevertheless, open cell stenting resulted in a significantly higher number of subclinical postprocedural new ischemic lesions detected on MR-DWI compared with closed cell stenting. An individualized patient data meta-analysis, including future studies with prospective homogenous study design, is required to adequately correct for known risk factors and to provide definite conclusions with respect to carotid stent design for specific subgroups.

AB - Objective: Procedural characteristics, including stent design, may influence the outcome of carotid artery stenting (CAS). A thorough comparison of the effect of stent design on outcome of CAS is thus warranted to allow for optimal evidence-based clinical decision making. This study sought to evaluate the effect of stent design on clinical and radiologic outcomes of CAS. Methods: A systematic search was conducted in MEDLINE, Embase, and Cochrane databases in May 2018. Included were articles reporting on the occurrence of clinical short- and intermediate-term major adverse events (MAEs; any stroke or death) or radiologic adverse events (new ischemic lesions on postprocedural magnetic resonance diffusion-weighted imaging [MR-DWI], restenosis, or stent fracture) in different stent designs used to treat carotid artery stenosis. Random effects models were used to calculate combined overall effect sizes. Metaregression was performed to identify the effect of specific stents on MAE rates. Results: From 2654 unique identified articles, two randomized, controlled trials and 66 cohort studies were eligible for analysis (including 46,728 procedures). Short-term clinical MAE rates were similar for patients treated with open cell vs closed cell or hybrid stents. Use of an Acculink stent was associated with a higher risk of short-term MAE compared with a Wallstent (risk ratio [RR], 1.51; P = .03), as was true for use of Precise stent vs Xact stent (RR, 1.55; P < .001). Intermediate-term clinical MAE rates were similar for open vs closed cell stents. Use of open cell stents predisposed to a 25% higher chance (RR, 1.25; P = .03) of developing postprocedural new ischemic lesions on MR-DWI. No differences were observed in the incidence of restenosis, stent fracture, or intraprocedural hemodynamic depression with respect to different stent design. Conclusions: Stent design is not associated with short- or intermediate-term clinical MAE rates in patients undergoing CAS. Furthermore, the division in open and closed cell stent design might conceal true differences in single stent efficacy. Nevertheless, open cell stenting resulted in a significantly higher number of subclinical postprocedural new ischemic lesions detected on MR-DWI compared with closed cell stenting. An individualized patient data meta-analysis, including future studies with prospective homogenous study design, is required to adequately correct for known risk factors and to provide definite conclusions with respect to carotid stent design for specific subgroups.

KW - Carotid artery stenting

KW - MR-DWI

KW - Meta-analysis

KW - Stent design

KW - Stroke

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U2 - 10.1016/j.jvs.2018.11.017

DO - 10.1016/j.jvs.2018.11.017

M3 - Review article

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SP - 1952-1961.e1

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de Vries EE, Meershoek AJA, Vonken EJ, den Ruijter HM, van den Berg JC, de Borst GJ et al. A meta-analysis of the effect of stent design on clinical and radiologic outcomes of carotid artery stenting. Journal of Vascular Surgery. 2019 Jun;69(6):1952-1961.e1. https://doi.org/10.1016/j.jvs.2018.11.017