Comparative effectiveness of commonly used devices for carotid artery stenting: an NCDR Analysis (National
Jay Giri1, Kevin F Kennedy2, Ido Weinberg3
1Cardiovascular Medicine Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Insights
Carotid stenting platforms like Acculink/Accunet, Xact/Emboshield, and Precise/Angioguard show similar low adverse event rates in U.S. practice. This study analyzed usage and outcomes of these common carotid artery stenting devices.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Carotid artery stenting involves various stent and embolic protection devices (EPDs).
- Current usage patterns and outcome differences among these devices are not well-documented.
Purpose of the Study:
- To characterize the usage patterns of different carotid stenting platforms.
- To compare the outcomes, specifically in-hospital death/stroke rates, associated with these platforms.
Main Methods:
- Analysis of 12,135 carotid stent procedures from the NCDR CARE registry (2007-2012).
- Comparison of baseline characteristics and adverse event rates for Acculink/Accunet, Xact/Emboshield, and Precise/Angioguard stent/EPD combinations.
- Utilized crude and multivariable-adjusted analyses to assess outcomes.
Main Results:
- Acculink/Accunet, Xact/Emboshield, and Precise/Angioguard were the most frequently used stent/EPD combinations, accounting for 72.7% of cases.
- In unadjusted and adjusted analyses, no statistically significant differences in in-hospital death/stroke rates were found between the primary stent/EPD systems.
- The Precise/Angioguard system showed a trend towards higher adverse events, but this was not statistically significant.
Conclusions:
- The Acculink/Accunet, Xact/Emboshield, and Precise/Angioguard carotid stenting systems are widely used in contemporary U.S. practice.
- These commonly used systems are associated with comparable and low rates of in-hospital adverse events.
- Findings support the safety and similar efficacy of major carotid stenting platforms in real-world application.
Objectives:
This study sought to characterize usage and outcomes of carotid stenting platforms.
Background:
A variety of stents and embolic protection devices (EPDs) are used for carotid artery stenting. Little is known about current usage patterns and differences in outcomes with these devices.
Methods:
We analyzed 12,135 consecutive carotid stent procedures in the NCDR (National Cardiovascular Data Registry) CARE (Carotid Artery Revascularization and Endarterectomy) registry performed between January 1, 2007 and March 31, 2012. We compared baseline characteristics and crude and multivariable-adjusted rates of in-hospital combined death/stroke among patients treated with Acculink/Accunet (Abbott Laboratories, Abbott Park, Illinois), Xact/Emboshield (Abbott), and Precise/Angioguard (Cordis Corporation, Bridgewater, New Jersey) stent/EPD combinations.
Results:
In 78.2% of cases, stents were used in conjunction with their specific, corresponding U.S. Food and Drug Administration-approved EPD. The Acculink/Accunet (n = 2,617, 21.6%), Xact/Emboshield (n = 3,507, 28.9%), and Precise/Angioguard (n = 2,696, 22.2%) stent/EPD combinations were used in 72.7% of all cases. The Protégé/SpiderFx (ev3 Endovascular Inc., Plymouth, Minnesota) (n = 453, 3.7%) and Wallstent/Filterwire (Boston Scientific, Natick, Massachusetts) (n = 213, 1.8%) devices were used in a minority of cases. In unadjusted analyses, the Precise/Angioguard system was associated with higher rates of the primary outcome than were the Acculink/Accunet (2.5% vs. 1.8%; p = 0.058) and Xact/Emboshield (2.5% vs. 1.9%; p = 0.14) systems that were not statistically different. In adjusted analyses, differences between Precise/Angioguard and Accunet/Acculink (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 0.89 to 2.47; p = 0.065), Precise/Angioguard and Xact/Emboshield (OR: 1.16, 95% CI: 0.77 to 1.76; p = 0.38), and Xact/Emboshield and Accunet/Acculink (OR: 1.28, 95% CI: 0.82 to 1.97; p = 0.18) remained nonsignificant.
Conclusions:
In modern U.S. practice, the Acculink/Accunet, Xact/Emboshield, and Precise/Angioguard carotid stenting systems are used in most cases and are associated with similarly low rates of adverse events.
