Stent Coning Induces Distal Stent Edge Stenosis | 45833

Journal of Neurology & Neurophysiology

ISSN - 2155-9562


Stent Coning Induces Distal Stent Edge Stenosis

Masanori Tsutsumi, Taichirou Mizokami, Kimiya Sakamoto, Sumito Narita, Kanji Nakai, Minoru Iko, Iwae Yu, Takafumi Mitsutake, Ayumu Eto, Hayatsura Hanada, Hiroshi Aikawa and Kiyoshi Kazekawa

Purpose: Stent coning is conular morphological changes at the distal end of wire-braided closed-cell stents. We
discuss its incidence, predictors, and outcomes.
Materials and Methods: We reviewed data on 178 carotid arteries (172 patients) that were treated by carotid
artery stenting (CAS) with wire-braided stents. All patients were followed-up by carotid duplex ultrasound (DUS)
studies to detect in-stent restenosis (ISR) and stent-edge stenosis. In patients manifesting stent coning, we also
obtained neck radiographs.
Results: Stent coning was detected in 11 arteries (6.2%). Internal carotid artery/common carotid artery ratio and
use of a post dilation balloon were associated with coning (p<0.05). On radiographs obtained at 3-months follow-up,
all instances of coning had disappeared spontaneously. Follow-up DUS detected 5 instance of stent-edge stenosis
at 3- or 6 months. Stent-edge stenosis occurred only in arteries with coning. At 6 months post-CAS, Kaplan-Meier
analysis revealed a cumulative freedom from stent-edge stenosis of 54.5% in vessels with coning; stent-edge stenosis
was not observed in arteries without coning (p<0.05). At DUS follow-up performed a mean of 32.8 months post-CAS,
2 arteries without coning manifested ISR >50% (p=0.72). At clinical follow-up carried out a mean of 38.4 months after
the procedure, none of our patients had developed new neurologic ischemic symptoms.
Conclusions: While stent coning is self-curing, it may be associated with the late development of stent-edge