Unprotected carotid artery stenting in modern practice

Area of Science:

• Cardiovascular Interventions
• Neurology
• Medical Devices

Background:

• Embolic protection devices (EPDs) are recommended to reduce peri-procedural strokes during carotid artery stenting (CAS).
• Medicare mandates EPD use for reimbursement, yet clinical outcome data remain mixed.
• Unprotected CAS is performed in a small but notable percentage of procedures.

Purpose of the Study:

• To characterize patients undergoing unprotected CAS.
• To assess the effectiveness of distal filter EPDs (F-EPDs) in elective CAS procedures.
• To evaluate the association between F-EPD use and major adverse events (MAE).

Main Methods:

• Analysis of patients from the CARE Registry® undergoing CAS (May 2005 - January 2012).
• Comparison of outcomes between patients who received F-EPDs versus those who did not (No-EPD).
• Unadjusted and 1:3 propensity-matched analyses to assess the composite of in-hospital death or stroke (MAE).

Main Results:

• 4.4% of CAS cases were performed without EPD.
• Patients in the No-EPD group had significantly higher pre-procedure neurologic risk factors.
• No significant difference in MAE was observed between No-EPD and F-EPD groups in elective cases, both unadjusted and propensity-matched.

Conclusions:

• Patients undergoing unprotected CAS often present with substantial pre-procedure neurologic risks.
• Filter EPDs did not demonstrate a significant benefit or harm in elective CAS patients in this analysis.
• Further research may be needed to clarify the role of EPDs in specific patient subgroups.