Embolic protection devices for carotid artery stenting: is there a difference between filter and distal occlusive
Ralf Zahn1, Thomas Ischinger, Bernd Mark
1Herzzentrum, Kardiologie, Ludwigshafen, Germany. erzahn@aol.com
Insights
Filter embolic protection devices (F-EPD) and distal occlusive embolic protection devices (DO-EPD) show equal effectiveness in preventing stroke during carotid artery stenting (CAS). This study found no significant difference in clinical events between the two EPD types.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Neurosurgery
Background:
- Embolic protection devices (EPDs) aim to reduce periprocedural cerebral ischemic events during carotid artery stenting (CAS).
- The comparative effectiveness of different EPD types, specifically filter embolic protection devices (F-EPD) and distal occlusive embolic protection devices (DO-EPD), remains unclear.
Purpose of the Study:
- To compare the efficacy of F-EPD versus DO-EPD in patients undergoing CAS.
- To evaluate the safety and effectiveness of different EPD strategies in reducing stroke risk during CAS.
Main Methods:
- Analysis of data from the prospective Carotid Artery Stent (CAS) Registry, including 1,734 patients from July 1996 to July 2003.
- Comparison of outcomes between 729 patients treated with EPDs (553 F-EPD, 176 DO-EPD).
- Multivariate analysis to assess the combined endpoint of in-hospital death or stroke.
Main Results:
- Patients treated with DO-EPD had more symptomatic stenosis and more complex carotid lesions (ulcers, calcification, longer length, higher stenosis grade).
- Intervention duration was shorter with DO-EPD (30 min) compared to F-EPD (48 min).
- No significant difference in the rate of combined in-hospital death or stroke was observed between DO-EPD (2.3%) and F-EPD (1.8%) groups (adjusted odds ratio = 1.04, p = 0.958).
Conclusions:
- Both F-EPD and DO-EPD appear equally effective in preventing periprocedural stroke during CAS.
- Despite differences in patient and lesion characteristics, neither device type demonstrated superior clinical outcomes.
- Filter EPD is currently the preferred method in clinical practice, though DO-EPD offers comparable safety and efficacy.
Objectives:
We sought to compare the efficacy of a filter embolic protection device (F-EPD) and a distal occlusive embolic protection device (DO-EPD) in patients undergoing carotid artery stenting (CAS).
Background:
The embolic protection device (EPD) may lower the periprocedural rate of cerebral ischemic events during CAS. However, it is unclear whether there is a difference in effectiveness between the different types of EPD.
Methods:
We analyzed data from the Carotid Artery Stent (CAS) Registry.
Results:
From July 1996 to July 2003, 1,734 patients were included in the prospective CAS Registry. Of these patients, 729 patients were treated with an EPD, 553 (75.9%) with F-EPD, and 176 (24.1%) with DO-EPD. Patients treated with DO-EPD were more likely to be treated for symptomatic stenosis (64.5% vs. 53.4%, p = 0.011). The carotid lesions in patients treated under DO-EPD seemed to be more complicated, as expressed by a higher proportion of ulcers (p = 0.035), severe calcification (p = 0.039), a longer lesion length (p = 0.025), and a higher pre-interventional grade of stenosis (p < 0.001). The median duration of the CAS intervention was 30 min in the DO-EPD group, compared with 48 min in the filter group (p < 0.001). No differences in clinical events rate between the two groups of protection devices were observed. Multivariate analysis on the occurrence of the combined end point of in-hospital death or stroke found no difference between filter- and DO-EPD (4 of 176 [2.3%] for DO-EPD vs. 10 of 551 [1.8%] for F-EPD; adjusted odds ratio = 1.04, 95% confidence interval 0.24 to 4.44; p = 0.958).
Conclusions:
Filter EPD is the currently preferred method of EPD in clinical practice. Both F-EPD and DO-EPD seem to be equally effective during CAS.
