{"doi":"10.1016/j.jvs.2025.02.025","title":"Carotid artery stenting with open vs closed stent cell configurations in the CREST-2 Registry","abstract":"Objective Intraprocedural atheroembolization during carotid artery stenting (CAS) can be reduced through careful patient selection, consideration of vascular anatomy and lesion characteristics, operator and institutional experience, peri-procedural antithrombotic and antiplatelet therapy, and use of embolic protection. However, CAS can also result in stroke as the stent is deployed and embolic protection withdrawn. The free-cell area of most closed-cell stents is <5 mm 2 , and ≥5 mm 2 for open-cell stents. The larger area may permit escape of more atheromatous debris. Comparisons of clinical outcomes between closed-cell and open-cell stents have been inconclusive. The aim of this study is to compare clinical outcomes associated with CAS using open-cell vs closed-cell stents. Methods The CREST-2-Registry (C2R) enrolls asymptomatic and symptomatic patients for whom CAS is favored because of high risk for surgery or patient preference. C2R implements operator- and site-credentialing, careful lesion selection, and standardized procedural protocols. Patient characteristics, procedural details, and outcomes are recorded. Interventionists may use United States Food and Drug Administration-approved devices including open-cell stents (Rx Acculink [Abbott Vascular], Precise Pro Rx [Cordis-Cardinal Health], and Protégé Rx [Medtronic/Covidien]), or closed-cell stents (XACT [Abbott Vascular] and Wallstent Monorail Endoprosthesis [Boston Scientific]). Multivariable logistic regression was used to assess relate stent cell configuration to peri-procedural (30-day) stroke or death (SD). Results Of 5307 procedures performed by 163 interventionists across 101 clinical centers, 2054 (38.7%) received open-cell stents, and 3253 (61.3%) received closed-cell stents. In the periprocedural period, 91 patients (1.7%) experienced a stroke (3 were fatal), and 16 patients died without experiencing strokes (0.4%). After adjusting for age, sex, symptomatic status, and case urgency, and for effect-modification by indication, periprocedural SD was significantly higher when an open-cell stent was placed in a primary lesion compared with closed-cell stents (3.5 events per 100 procedures using open-cell stents [95% confidence interval [CI], 2.6-4.7] vs 2.2% [95% CI, 1.6-3.0] using closed-cell stents (odds ratio, 1.59; 95% CI, 1.13-2.23; P < .01). Periprocedural SD was not significantly different between stent types when placed in a restenotic lesion (1.2% [95% CI, 0.4-3.3]) using open-cell stents vs 4.0% (95% CI, 2.2-7.2) using closed-cell stents (odds ratio, 0.31; 95% CI, 0.09-1.01; P = .052). Conclusions Stent design influences periprocedural stroke or death in carotid stenting. Closed-cell stents are associated with a lower event rate when treating primary atherosclerosis, but not in the setting of restenosis.","journal":"Journal of Vascular Surgery","year":2025,"id":517130,"datarank":0.3977301781869188,"base_score":2.1972245773362196,"endowment":2.1972245773362196,"self_citation_contribution":0.32958368660043297,"citation_network_contribution":0.06814649158648582,"self_endowment_contribution":0.32958368660043297,"citer_contribution":0.06814649158648582,"corpus_percentile":null,"corpus_rank":null,"citation_count":8,"citer_count":7,"citers_with_citation_signal":3,"citers_with_endowment":3,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9508,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT02240862"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1139291,"name":"Gary S. Roubin","orcid":"0000-0002-3246-9239","position":1,"is_corresponding":false},{"id":287569,"name":"James F. Meschia","orcid":"0000-0002-4475-8142","position":2,"is_corresponding":false},{"id":964878,"name":"Michael Jones","orcid":"0000-0001-9118-755X","position":3,"is_corresponding":false},{"id":756762,"name":"Donald Heck","orcid":null,"position":4,"is_corresponding":false},{"id":737843,"name":"W. Charles Sternbergh","orcid":null,"position":5,"is_corresponding":false},{"id":414422,"name":"Herbert D. Aronow","orcid":"0000-0002-9061-7893","position":6,"is_corresponding":false},{"id":414421,"name":"Carlos Mena‐Hurtado","orcid":"0000-0002-4954-5672","position":7,"is_corresponding":false},{"id":103407,"name":"George Howard","orcid":"0000-0002-3068-5720","position":8,"is_corresponding":false},{"id":471339,"name":"Minerva Mayorga‐Carlin","orcid":"0000-0003-2125-642X","position":9,"is_corresponding":false},{"id":260022,"name":"John D. Sorkin","orcid":"0000-0003-2496-0965","position":10,"is_corresponding":false},{"id":287566,"name":"Thomas G. Brott","orcid":"0000-0002-1266-0941","position":11,"is_corresponding":false},{"id":317933,"name":"Brajesh K. Lal","orcid":"0000-0001-6724-8201","position":0,"is_corresponding":true}],"reference_count":22,"raw_metadata":null,"created_at":"2026-07-19T02:48:54.768083Z","pmid":"40024381","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}