Purpose Stent design is one of the risk factors associated with periprocedural ischemic complications during carotid artery stenting (CAS). Closed-cell stents have a lower rate of ischemic complications than open-cell stents, and it has been reported that this is because closed-cell stents have a smaller free cell area, restricting plaque protrusion (PP). Reducing the free cell area of stents may thus reduce the incidence of ischemic complications. We examine whether the use of overlapped (i.e., double) closed-cell stents in CAS for carotid artery stenosis with unstable plaque might inhibit plaque protrusion (PP).

Methods 41 consecutive patients with carotid artery stenosis with unstable plaque diagnosed by magnetic resonance plaque imaging (35 men; [mean 76.3 years]; symptomatic stenosis, 28 lesions; mean stenosis severity, 84.8%) were prospectively analyzed. All CAS procedures were performed by conservative post-dilatation after stent-in-stent placement of two Carotid Wallstents using an embolic protection device. The technical success rate and the incidence of PP, ischemic stroke within 30 days, and new ipsilateral ischemic lesions on diffusion-weighted imaging (DWI) within 48 h after CAS and follow-up results (ipsilateral stroke rate and restenosis rate) were prospectively assessed.

Results The technical success rate was 100% (41/41). No PP and stroke occurred in any patients. New ischemic lesions were observed on DWI in 11 patients (26.8%). During the follow-up period (mean 11.6 months), no ipsilateral strokes occurred. Asymptomatic restenosis (53%) occurred in 1 patient (2.9%); asymptomatic occlusion occurred in 1 patient (2.9%).

Conclusion CAS using overlapped double stents for unstable plaque may be useful for preventing PP and ischemic complications.

Disclosures K. Takayama: None. K. Myouchin: None. T. Wada: None. S. Kurokawa: None. K. Kichikawa: None.