Tapered Stent Geometry Provides Strong Hemodynamic Effect After Carotid Stenting.

Objective: In the last years, development of materials allowed notably improvements in interventional approach to stroke. Tapered stents were specifically designed for extracranial carotid stenting (CAS) to deal with vessels mismatch decreasing the risk of thrombosis. Nevertheless, as to whether the stent geometry may affect the hemodynamic consequences of CAS remains uncertain. This study aims to investigate the impact of stent configuration on postprocedural sustained hemodynamic depression (HD) requiring action of care after carotid stenting (CAS). Methods: Data on 391 consecutive CAS performed over a 4-year period (2011-2014) were reviewed. Postprocedural sustained HD was defined as any severe hypotension (<90mmHg) or bradicardia (<50beats/min) persisting at >2 measurements after the end of the procedure and requiring care support or delaying hospital discharge. Stent configuration (tapered or straight) was tested for association with sustained HD using multivariable models adjusted for other confounders (medical therapy, comorbidities, symptoms, stenosis, carotid plaque and demographics).The relation with stroke and death outcomes within 30 days of treatment was also analyzed. Results: Mean age of patients was 70.7y + 7.14 and 66.2% were males. Sustained HD developed after 144 (36.8%) CAS. Tapered stents were applied in 289 (73.9%) CAS, and more frequently in patients with higher degree of stenosis (mean 79% vs 77%, in tapered and straight stents respectively; P=0.007) or asymptomatic (93.8% vs. 85.3% in tapered and straight stents respectively;P=0.012). Diabetes (HR 1.6, 95% CI, 1.01-2.44;P=0.044) and tapered stent configuration (HR, 1.7, 95% CI, 1.05-2.82;P=0.033) were the only factors that showed independent association with sustained HD. At 30-day, 3 strokes and no death occurred. There was no statistically significant association between 30-day outcomes and sustained HD depression or stent configuration. Conclusions: A strong hemodynamic effect, requiring additional actions of care or prolonged hospital stay, is expected after CAS when using tapered stent configuration. These findings alert on the overall benefit and costs of CAS and the requirements for accurate material selection especially in diabetic patients.