Surgical Removal of Self-Expanding Stents from the Carotid Artery: Does the Type of Stent Make a Difference?

Abstract

Purpose:

To evaluate the degree of difficulty in surgically removing 2 different stent models placed in the canine carotid artery.

Methods:

In 5 dogs, each carotid artery was stented with a braided Elgiloy self-expanding stent (BESES) on one side and a surface-spanning micro stent (SSMS) on the other. After 4 weeks, an arteriogram was obtained, and the stents were removed via direct surgical exposure. The minimum lengths of the skin incisions and arteriotomies, the ease of stent removal, and the presence of a distal intimal flap were recorded.

Results:

Stent deployment and removal were successful in each animal, but there was a substantial difference in the ease of removal. The BESES could be removed in a strand-by-strand fashion via a more proximal, smaller arteriotomy compared to the SSMS (8.8±1.3 versus 37.2±4.7 mm, p<0.01). Furthermore, a smaller skin incision (3.85±0.9 versus 9.75±0.5 cm, p<0.01) was required for the BESES. There was no distal flap formation following BESES removal, whereas SSMS removal produced a large distal flap in each artery (p<0.01).

Conclusions:

Although rare, restenosis after stenting occurs, and surgical repair may become necessary in some patients. Each stent has inherent advantages and disadvantages, but the braided Elgiloy self-expanding stent lends itself to easier surgical removal, which may have important clinical implications, especially when used in the carotid artery.