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Original research
Safety and efficacy of an open-cell stent and double-balloon protection for unstable plaques: analysis of 184 consecutive carotid artery stentings
  1. Yusuke Funakoshi1,
  2. Hirotoshi Imamura1,
  3. Shoichi Tani1,
  4. Hidemitsu Adachi1,
  5. Ryu Fukumitsu1,
  6. Tadashi Sunohara1,
  7. Yoshihiro Omura1,
  8. Yuichi Matsui1,
  9. Natsuhi Sasaki1,
  10. Tatsumaru Fukuda1,
  11. Ryo Akiyama1,
  12. Kazufumi Horiuchi1,
  13. Shinji Kajiura1,
  14. Masashi Shigeyasu1,
  15. Koji Iihara2,
  16. Nobuyuki Sakai1
  1. 1 Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
  2. 2 Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  1. Correspondence to Dr Yusuke Funakoshi, Neurosurgery, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan; sf1wan0610{at}


Introduction In our institute, most cases of carotid artery stenosis are treated by carotid artery stenting (CAS) with an open-cell stent and double-balloon protection, even if plaques are unstable. This study was performed to examine the outcome of CAS with an open-cell stent and double-balloon protection for unstable plaques.

Methods A total of 184 CAS procedures in our institute between October 2010 and February 2018 were assessed. Ultrasonography findings of low-echo plaques, plaque ulceration, or both were defined as unstable plaques. A plaque-to-muscle ratio (PMR) of >1.8 on T1-weighted black blood imaging using spin-echo was also defined as an unstable plaque. Seventy-four unstable plaques on ultrasonography and 86 unstable plaques evaluated by PMR were included. Open-cell stents and double-balloon protection (proximal balloon protection during lesion crossing and distal balloon protection after lesion crossing) were used in all cases.

Results On ultrasonography, perioperative asymptomatic thromboembolization was significantly more frequent in the unstable plaque group (39/74, 52.7%) than in the stable plaque group (41/110, 37.3%, p=0.0384). Asymptomatic thromboembolization was also significantly more frequent in the PMR >1.8 group (44/86, 51.2%) than in the PMR <1.8 group (36/98, 36.7%, p=0.0489). However, symptomatic thromboembolization was rare (n=5, 2.7%), and all of these patients had minor stroke. During the 4-year follow-up, the risk of ipsilateral stroke was 0.28% and 0.27% per year in patients with symptomatic and asymptomatic lesions, respectively.

Conclusions The outcomes of CAS with an open-cell stent and double-balloon protection are acceptable. This method is effective and safe, even if carotid artery stenosis comprises unstable plaques.

  • plaque
  • stenosis
  • stent
  • stroke

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  • Contributors All authors meet the ICMJE authorship criteria. YF designed this study and wrote the initial draft of the manuscript. All other authors critically reviewed the manuscript and assisted in the preparation of the manuscript. All authors approved the final version of the manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.