Safety and efficacy of different stent types in single-stage carotid artery stenting for extracranial and intracranial tandem carotid lesions

Objective To compare the safety and efficacy differences between self-expanding stents (SES) and balloon-expandable stents (BES) in single-stage carotid artery stenting (CAS) for tandem carotid lesions (TCL) involving both extracranial and intracranial carotid segments. Methods Clinical data from 48 patients who underwent single-stage CAS for TCL at the First Affiliated Hospital of Xi′an Jiaotong University between January 2016 and September 2019 were retrospectively analyzed. Based on the stent type deployed in the intracranial segment, patients were divided into SES (n=23) and BES (n=25) groups. Follow-up was initiated at 1 month postoperatively and conducted monthly via outpatient visits or telephone. Baseline characteristics, perioperative adverse event rates, long-term stroke-free survival, and primary stent patency rates between the two groups were compared. Survival curves were constructed using the Kaplan-Meier method. Results The age of the 48 patients was (65±11) years, including 30 males and 18 females. The technical success rate was 100% (48/48). No significant difference was found in perioperative complication rates between SES and BES groups [8.7% (2/23) vs 4.0% (1/25)]. Cerebral hyperperfusion syndrome occurred in 1 case in each group (4.3% and 4.0%). One ischemic stroke (4.3%) occurred in the SES group. There were no death or major adverse cardiovascular event during the perioperative period in either group. The follow-up time [M(Q₁, Q₃)] was 38 (14,45) months for the SES group and 36 (15,45) months for the BES group. During follow-up, the SES group experienced 1 (4.3%) major adverse cardiovascular event, 2 (8.7%) stroke events, and 2 (8.7%) cases of in-stent restenosis, while the BES group had 1 (4.0%) major adverse cardiovascular event and 1 (4.0%) case of in-stent restenosis. No statistically significant differences were observed in stroke-free survival (78.3% vs 92.0%) or primary patency rates (91.3% vs 96.0%) between the two groups (both P>0.05). Conclusion With strict patient selection and standardized perioperative management, single-stage CAS for TCL demonstrated excellent technical success and acceptable safety.