A meta-analysis of proximal occlusion device outcomes in carotid artery stenting
Robert M Bersin1, Eugenio Stabile, Gary M Ansel
1Department of Cardiology, Swedish Medical Center, Seattle, Washington, USA. robert.bersin@swedish.org
Insights
Carotid artery stenting with proximal occlusion devices shows low adverse events. Age and diabetes are the only predictors of risk, with stroke rates remaining low across patient groups.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
- Neurology
Background:
- Established risk predictors exist for carotid stenting with distal embolic protection devices.
- Risk predictors for proximal occlusion devices in carotid stenting are less defined.
- This meta-analysis investigates risk predictors for proximal occlusion devices in carotid stenting.
Purpose of the Study:
- To identify independent risk predictors for adverse events in carotid artery stenting (CAS) utilizing proximal occlusion devices.
- To evaluate the safety and efficacy of CAS with proximal occlusion devices.
Main Methods:
- A meta-analysis of 2,397 patients from six databases using two proximal occlusion devices.
- Random effects models were employed to identify predictors of 30-day major adverse clinical events (MACE).
- MACE included stroke, myocardial infarction, and death.
Main Results:
- The incidence of stroke was 1.71%, myocardial infarction 0.02%, and death 0.40%, with a composite MACE rate of 2.25% at 30 days.
- Age and diabetes were the sole significant independent risk predictors identified.
- Stroke rates remained below 2.6% even in high-risk subgroups, including symptomatic octogenarians.
Conclusions:
- Carotid artery stenting with proximal occlusion devices demonstrates a low incidence of 30-day adverse events.
- Age and diabetes are the only independent risk predictors for CAS using proximal occlusion devices.
- Patient gender, symptomatic status, and other baseline characteristics were not significant risk predictors.
Background:
The clinical risk predictors for adverse events in carotid stenting using distal embolic protection devices are well established and include patient age and symptomatic status. The risk predictors for adverse events with proximal occlusion devices are not as well established. This study is a meta-analysis of available data on proximal occlusion devices to determine the risk predictors of adverse events in carotid stenting.
Methods:
Study-specific results on 2,397 patients from six independent databases of two different proximal occlusion devices were meta-analyzed by an independent statistical analysis organization for predictors of 30-day major adverse clinical events including stroke, myocardial infarction, and death using random effects models. The primary endpoint was the composite of total stroke, myocardial infarction, and death at 30 days.
Results:
The incidence of stroke was 1.71%. The incidence of myocardial infarction was 0.02%. The incidence of death was 0.40%. The composite primary endpoint at 30 days was 2.25%. Age and diabetic status were found to be the only significant independent risk predictors; however, total stroke rates remained below 2.6% in all subgroups, including symptomatic octogenarians. The other baseline demographic variables including patient gender, symptomatic status, and contralateral carotid occlusion were not found to be independent risk predictors.
Conclusions:
A meta-analysis of CAS procedures performed with proximal occlusion devices demonstrated a very low incidence of adverse events at 30 days. The only independent risk predictors were age and diabetes. Patient gender, symptomatic status, and other baseline characteristics were not found to be risk predictors for CAS using proximal occlusion devices.
