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The type of embolic protection does not influence the outcome in carotid artery stenting
Vikram Iyer1, Gianmarco de Donato, Koen Deloose
1Department of Vascular Surgery, AZ St-Blasius, Dendermonde, Belgium.
Insights
Embolic protection devices (EPDs) in carotid artery stenting (CAS) show a low procedural adverse event risk. Differences in 30-day outcomes may relate to stent type rather than EPD device or type.
Area of Science:
- Cardiovascular Interventions
- Medical Device Technology
- Vascular Surgery
Background:
- Carotid artery stenting (CAS) is a procedure to open blocked carotid arteries.
- Embolic protection devices (EPDs) are used during CAS to prevent debris from traveling to the brain.
- Evaluating the clinical effectiveness and comparing outcomes of different EPDs is crucial for optimizing patient safety.
Purpose of the Study:
- To review the clinical experience with embolic protection devices (EPDs) during carotid artery stenting (CAS).
- To verify the clinical effectiveness of EPDs in CAS procedures.
- To compare clinical outcomes between specific EPD devices and EPD types.
Main Methods:
- Retrospective review of carotid artery stenting (CAS) databases from four centers.
- Analysis of adverse events including death, stroke, and transient ischemic attack (TIA).
- Comparison of procedural and 30-day event risks between protected and unprotected CAS, and among different EPDs and types.
Main Results:
- A total of 3160 CAS procedures utilizing nine EPDs were analyzed.
- The procedural adverse event rate was 0.9% with EPD protection versus 2.3% without (P = .12).
- No significant procedural adverse event differences were found between most EPDs, but the Accunet filter showed increased 30-day adverse events compared to FilterWire (RR 2.67, P = .005).
Conclusions:
- Embolic protection devices (EPDs) are associated with a low risk of procedural adverse events during carotid artery stenting (CAS).
- No significant differences in procedural adverse event risks were detected between various EPD devices or types.
- Observed 30-day outcome differences are potentially attributable to variations in stent types used.
Objectives:
The goal of this study was to review our experience with embolic protection devices (EPDs) during carotid artery stenting (CAS). Specifically, we aimed to verify their clinical effectiveness and to compare clinical outcomes between specific devices and types of EPDs.
Methods:
The CAS databases at four participating centers were reviewed. Adverse events were defined as death, stroke (>24 hours), or transient ischemic attack (TIA) (<24 hours). We compared the risk of procedural and 30-day events between patients treated with and without an EPD. We also compared these risks between different EPDs and between the different types of EPDs.
Results:
A total of 3160 CAS procedures using nine EPDs were analyzed. The risk of a procedural adverse event was 0.9% in protected and 2.3% in unprotected procedures (P = .12). Compared with the most frequently used device (FilterWire, Boston Scientific, Natick, Mass), there was no significant difference in the risk of procedural adverse events for any of the other EPDs. There was, however, an increased risk of 30-day adverse events with the Accunet (Abbott Vascular, Redwood, Calif) filter compared with the FilterWire (relative risk [RR] 2.67, confidence interval [CI] 1.41 to 5.04, P = .005). Pairwise comparison of proximal occlusion balloons to filters, distal occlusion balloons to filters, and proximal to distal occlusion balloons revealed no significant difference in the risk of procedural or 30-day adverse events. There was no significant difference in risk of procedural events between eccentric and concentric filters, however, the relative risk of eccentric compared with concentric filters at 30 days was 0.59 (unadjusted, CI 0.38 to 0.92, P = .04). This difference was still apparent after adjustment for risk factors (RR 0.61, CI 0.39 to 0.95, P = .06), but not after adjustment for risk factors and stent-type [(open-cell vs closed-cell) RR 0.76, CI 0.47 to 1.22, P = .51].
Conclusion:
The use of EPDs is associated with a low risk of procedural adverse events. We were unable to detect significant differences in risks of procedural adverse events between different devices or types of devices. We speculate that the observed differences seen at 30 days are largely attributable to differences in stent-type used.
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