Study finds carotid stent fracture rate to be negligible but long-term research needed

Neeta Karani, MD

Presenter Neeta Karani, MD, from Bronson Healthcare, Kalamazoo, Michigan, is set to elucidate findings that consider the incidence of carotid stent fractures and their impact on carotid stent durability during Plenary Session 2 (9:45–11 a.m.) in Potomac A/B at the Vascular Annual Meeting (VAM) 2023. 

Research from Karani and colleagues—including senior author Robert Molnar, MD, from Michigan Vascular Center—comes against the backdrop of the recent approval of transcarotid artery revascularization (TCAR) for asymptomatic patients by the Centers for Medicare and Medicaid Services (CMS), which, by proxy, has increased the number of carotid artery stenting (CAS) procedures being performed today. Subsequently, Karani, alongside coauthor Subbaiah Perla, a professor of statistics at Oakland University in Rochester, Michigan, identified a number of carotid stent fractures in their practice, and so set about investigating the prevalence of this condition and its influence on the efficacy of CAS.

Conducting a prospective trial, the researchers enrolled 200 patients who had undergone CAS between January 2002 and November 2021. Karani et al then evaluated these patients for stent fractures via anterior-posterior (AP) and lateral cervical X-rays. These X-rays were independently reviewed by three vascular surgeons, who, upon complete consensus, identified those patients who had definitive stent fractures. Additionally, Karani and colleagues applied a modification to their study that allowed for a second X-ray to be obtained at a later date to assess the potential for late fracture development in their patient cohort.

Their primary outcome measure was defined as the incidence of carotid stent fracture, followed by a secondary measure which was an evaluation of the clinical implications associated with the condition upon confirmed identification.

In the 200 patients who consented and were enrolled in the study, a total of 227 stent procedures were performed over the duration of Karani and her team’s investigation. In the first wave of X-rays obtained by the team, they identified 18 stent fractures, amounting to a stent fracture rate of 7.9%. Karani will go on to report that 103 patients additionally received a second/delayed X-ray, which amounted to a total of 117 X-rays obtained. In these patients, a further six stent fractures were discovered for a delayed fracture rate of 5.6%.

The total number of fractures found by the researchers amounted to 24, representing an overall stent fracture rate of 10.6%. Karani et al will explain that, of those with stent fractures, duplex assessment in the follow-up period pinpointed only one severe case of recurrent stenosis that required intervention—further designating a 4.2% reintervention rate for their patient cohort.

Karani is set to expand on the study’s conclusions which found that, among patients who had undergone CAS placement, a total stent fracture rate of 10.6% was identified, with a total delayed fracture rate of 5.6%. “While we have identified that carotid stent fractures do occur, the follow-up duplex examinations revealed minimal restenosis, with only one reintervention required. Our study indicates that the CAS fracture rate is approximately 10% and the clinical sequelae appear to be negligible,” Karani is set to explain in her presentation.

Furthermore, Karani and her team posit that their research intends to emphasize the need for further prospective studies with long-term outcomes that acknowledge the increased occurrence of carotid stenting in the treatment of patients today.

In doing so, they seek to highlight that future research in this arena should draw particular attention to stent fractures and reintervention rates as matters of pointed importance.


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