Findings that consider the incidence of carotid stent fractures and their impact on stent durability were elucidated by Neeta Karani (Bronson Healthcare, Kalamazoo, USA) during a plenary session at this week’s Vascular Annual Meeting (VAM; 14–17 June 2023, National Harbor, USA).
Research from Karani and colleagues—including senior author Robert Molnar (Michigan Vascular Center, Flint, USA)—comes against the backdrop of the recent approval of transcarotid artery revascularisation (TCAR) for asymptomatic patients by the Centers for Medicare and Medicaid Services (CMS), which, by proxy, has increased the number of carotid artery stenting (CAS) procedures being performed today. Subsequently, Karani, alongside co-author Subbaiah Perla (Oakland University, Rochester, USA), identified a number of carotid stent fractures in their practice, and so set about investigating the prevalence of this condition and its influence on the efficacy of CAS.
Conducting a prospective trial, the researchers enrolled 200 patients who had undergone CAS between January 2002 and November 2021. Karani et al then evaluated these patients for stent fractures via anterior-posterior (AP) and lateral cervical X-rays. These X-rays were independently reviewed by three vascular surgeons who, upon complete consensus, identified those patients who had definitive stent fractures. Additionally, Karani and colleagues applied a modification to their study that allowed for a second X-ray to be obtained at a later date to assess the potential for late fracture development in their patient cohort.
Their primary outcome measure was defined as the incidence of carotid stent fracture, followed by a secondary measure which was an evaluation of the clinical implications associated with the condition upon confirmed identification.
In the 200 patients who consented and were enrolled in the study, a total of 227 stent procedures were performed over the duration of Karani and her team’s investigation. In the first wave of X-rays obtained by the team, they identified 18 stent fractures, amounting to a stent fracture rate of 7.9%. Karani went on to report that 103 patients additionally received a second/delayed X-ray, which amounted to a total of 117 X-rays obtained. In these patients, a further six stent fractures were discovered for a delayed fracture rate of 5.6%.
The total number of fractures found by the researchers amounted to 24, representing an overall stent fracture rate of 10.6%. Karani explained that, of those with stent fractures, duplex assessment in the follow-up period pinpointed only one severe case of recurrent stenosis that required intervention—further designating a 4.2% reintervention rate for their patient cohort. Karani expanded on the study’s conclusions, noting a total delayed fracture rate of 5.6%.
“While we have identified that carotid stent fractures do occur, the follow-up duplex examinations revealed minimal restenosis, with only one reintervention required. Our study indicates that the CAS fracture rate is approximately 10% and the clinical sequelae appear to be negligible,” Karani posited in her presentation at VAM 2023.
Furthermore, Karani and her team posit that their research intends to emphasise the need for further prospective studies with long-term outcomes that acknowledge the increased occurrence of carotid stenting in the treatment of patients today. In doing so, they seek to highlight that future research in this arena should draw particular attention to stent fractures and reintervention rates as matters of pointed importance.
