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Carotid stenting and bivalirudin with and without vascular closure: 3-year analysis of procedural outcomes
Laurence M Schneider1, Sotir Polena, Gary Roubin
1Department of Cardiovascular Medicine, Lenox Hill Heart and Vascular Institute, 130 E. 77th Street, New York, NY 10065, USA.
Insights
Vascular closure devices (VCD) did not significantly alter hypotension during carotid stenting with bivalirudin. Bivalirudin remains safe for carotid stenting, showing low bleeding and acceptable adverse event rates.
Area of Science:
- Cardiovascular Interventions
- Vascular Surgery
- Interventional Cardiology
Background:
- Bivalirudin is an effective anticoagulant with lower bleeding risk than heparin in coronary interventions.
- Vascular closure devices (VCD) are standard for ambulation post-intervention.
- Combining bivalirudin and VCD may mitigate hypotension in carotid stenting.
Purpose of the Study:
- To evaluate carotid stenting outcomes using bivalirudin.
- To assess the impact of VCD on peri-procedural hypotension incidence and severity.
Main Methods:
- Analysis of 536 carotid stenting procedures in 514 patients (Sept 2004-Sept 2007).
- All patients received bivalirudin, with or without VCD.
- Evaluation of peri-procedural and 30-day outcomes, including hypotension and length of stay.
Main Results:
- 30-day stroke and death rate was 1.7%.
- Hypotension (systolic BP < 80 mm Hg) occurred in 15.4% of patients.
- VCD group had no prolonged hospital stay delays, unlike manual compression.
Conclusions:
- No significant difference in prolonged hypotensive events between VCD and manual compression groups with bivalirudin.
- VCDs demonstrated safety and efficacy with low complication rates.
- Bivalirudin is safe for carotid artery stenting, with low bleeding and acceptable 30-day adverse events.
Objectives:
The purpose of this study was to examine the outcome of carotid stenting using bivalirudin and the influence of vascular closure devices (VCD) on the incidence and severity of peri-procedural hypotension.
Background:
Bivalirudin, a short-acting direct thrombin inhibitor, has been shown to be an effective anticoagulant in coronary interventions, with less risk of bleeding compared with heparin. Routine use of VCD has become the standard of care, facilitating patient ambulation after percutaneous carotid and coronary interventions. The combined use of these two therapies (bivalirudin and VCD) may improve outcomes in carotid interventions where prolonged patient immobilization may exacerbate hypotension following stenting.
Methods:
A total of 514 patients underwent 536 carotid stenting procedures in the 3-year period from September 2004 to September 2007. All patients received adjunctive bivalirudin, with and without VCD. This cohort was analyzed for peri-procedural and 30-day clinical outcomes and length of hospitalization.
Results:
Thirty-day stroke and death rate was 1.7%. A total of 83 patients (15.4%) experienced intra- or post-procedural hypotension (systolic BP < 80 mm Hg). There were four (0.7%) major bleeding complications requiring transfusion, and length of stay was delayed more than 24 hr in five patients (0.93%), all of whom were in the manual compression group.
Conclusions:
This was a negative study, with no significant difference on prolonged hypotensive events in patients with vascular closure device and bivalirudin, compared with those with manual compression and bivalirudin. Vascular closure devices were safe and effective with a low incidence of complications. In carotid artery stenting, bivalirudin is safe with low incidence of major bleeding and acceptable 30-day adverse event rates (stroke and death).
