Are Carotid Stent Fractures Clinically Significant?

Journal Article · Sun Apr 15 00:00:00 EDT 2012 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-011-0149-3· OSTI ID:21608570

Garcia-Toca, Manuel; Rodriguez, Heron E; Naughton, Peter A ^[1]; Keeling, Aiofee ^[2]; Phade, Sachin V; Morasch, Mark D; Kibbe, Melina R

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1. Northwestern University Feinberg School of Medicine, Division of Vascular Surgery (United States)
2. Northwestern University Feinberg School of Medicine, Department of Radiology (United States)

Purpose: Late stent fatigue is a known complication after carotid artery stenting (CAS) for cervical carotid occlusive disease. The purpose of this study was to determine the prevalence and clinical significance of carotid stent fractures. Materials and Methods: A single-center retrospective review of 253 carotid bifurcation lesions treated with CAS and mechanical embolic protection from April 2001 to December 2009 was performed. Stent integrity was analyzed by two independent observers using multiplanar cervical plain radiographs with fractures classified into the following types: type I = single strut fracture; type II = multiple strut fractures; type III = transverse fracture; and type IV = transverse fracture with dislocation. Mean follow-up was 32 months. Results: Follow-up imaging was completed on 106 self-expanding nitinol stents (26 closed-cell and 80 open-cell stents). Eight fractures (7.5%) were detected (type I n = 1, type II n = 6, and type III n = 1). Seven fractures were found in open-cell stents (Precise n = 3, ViVEXX n = 2, and Acculink n = 2), and 1 fracture was found in a closed-cell stent (Xact n = 1) (p = 0.67). Only a previous history of external beam neck irradiation was associated with fractures (p = 0.048). No associated clinical sequelae were observed among the patients with fractures, and only 1 patient had an associated significant restenosis ({>=}80%) requiring reintervention. Conclusions: Late stent fatigue after CAS is an uncommon event and rarely clinically relevant. Although cell design does not appear to influence the occurrence of fractures, lesion characteristics may be associated risk factors.

• OSTI ID: 21608570
• Journal Information: Cardiovascular and Interventional Radiology, Vol. 35, Issue 2; Other Information: DOI: 10.1007/s00270-011-0149-3; Copyright (c) 2012 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Country of input: International Atomic Energy Agency (IAEA); ISSN 0174-1551
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CAROTID ARTERIES
DISEASES
DISLOCATIONS
FATIGUE
FRACTURES
HAZARDS
IMAGES
IRRADIATION
MATERIALS
NECK
NICKEL ALLOYS
PATIENTS
SAFETY
TITANIUM ALLOYS
ALLOYS
ARTERIES
BLOOD VESSELS
BODY
CARDIOVASCULAR SYSTEM
CRYSTAL DEFECTS
CRYSTAL STRUCTURE
FAILURES
LINE DEFECTS
MECHANICAL PROPERTIES
ORGANS
TRANSITION ELEMENT ALLOYS