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Eur J Vasc Endovasc Surg. 2017 May;53(5):617-625. doi: 10.1016/j.ejvs.2016.12.034. Epub 2017 Mar 11.

Choices of Stent and Cerebral Protection in the Ongoing ACST-2 Trial: A Descriptive Study.

Collaborators (426)

Fraedrich G8, Rantner B8, Gizewski E8, Gruber I8, Hendriks J9, Cras P9, Lauwers P9, van Scheil P9, Vermassen F10, Van Herzeele I10, Geenens M10, Hemelsoet D10, Lerut P11, Lambrecht B11, Saad G12, Peeters A13, Bosiers M14, da Silva E15, de Luccia N15, Sitrangulo JC Jr.15, Estenssoro AEV15, Presti C15, Casella I15, Monteiro JAT15, Campos W Jr.15, Puech-Leao P15, Petrov V16, Bachvarov C16, Hill M17, Mitha A17, Wong J17, Liu CW18, Bao L18, Yu C18, Cvjetko I19, Vidjak V19, Fiedler J20, Ostry S20, Sterba L20, Kostal P20, Staffa R21, Vlachovsky R21, Privara M21, Kriz Z21, Vojtisek B21, Krupa P21, Reif M21, Benes V22, Buchvald P22, Endrych L22, Prochazka V23, Kuliha M23, Otahal D23, Hrbac T23, Netuka D24, Mohapl M24, Kramier F24, Eldessoki M25, Heshmat H25, Abd-Allah F25, Palmiste V26, Margus S26, Toomsoo T26, Becquemin JP27, Bergeron P28, Abdulamit T28, Cardon JM29, Debus S30, Thomalla G30, Fiehler J30, Gerloss C30, Grzyska U30, Storck M31, LaMacchia E31, Eckstein HH32, Söllner H32, Berger H32, Kallmayer M32, Popert H32, Zimmermann A32, Guenther A33, Klingner C33, Mayer T33, Schubert J33, Zanow J33, Scheinert D34, Banning-Eichenseer U34, Bausback Y34, Branzan D34, Braünilch S34, Lenzer J34, Scheinert D34, Schidt A34, Staab H34, Ulirch M34, Barlinn J35, Haase K35, Abramyuk A35, Bodechtel U35, Gerber J35, Reeps C35, Pfeiffer T36, Torello G37, Bausback Y38, Branzan D38, Braünilch S38, Lenzer J38, Scheinert D38, Schidt A38, Staab H38, Ulirch M38, Cöster A39, Giannoukas A40, Spanos K40, Matsagkas M40, Koutias S40, Vasdekis S41, Kakisis J41, Moulakakis K41, Lazaris A41, Liapas C41, Brountzos E41, Lazarides M42, Ioannou N43, Polydorou A44, Moulakakis K45, Lazaris A45, Liapas C45, Brountzos E45, Fulop B46, Fako E46, Voros E46, Bodosi M46, Nemeth T46, Barzo P46, Pazdernyik S46, Entz L47, Szeberin Z47, Dosa E47, Nemes B47, Jaranyi Z47, Pazdernyia S47, Madhaban P48, Hoffman A49, Nikolsky E49, Beyar R49, Casana R50, Tolva V50, Silingardi R51, Lauricella A51, Coppi G51, Nicoloci E51, Tusini N52, Strozzi F52, Vecchiati E52, Ferri M53, Ferrero E53, Psacharopulo D53, Gaggiano A53, Viazzo A53, Farchioni L54, Parlani G54, Caso V54, De Rangoy P54, Verzini F54, Castelli P55, DeLodovici ML55, Carrafiello G55, Ierardi AM55, Piffaretti G55, Nano G56, Occhiuto MT56, Malacrida G56, Tealdi D56, Steghter S56, Stella A57, Pini R57, Faggioli G57, Sacca S58, Negri MD58, Palombo M59, Perfumo MC59, Fadda GF60, Kasemi H60, Cernetti C61, Tonello D61, Visonà A61, Mangialardi N62, Ronchey S62, Altavista MC62, Michelagnoli S63, Chisci E63, Speziale F64, Capoccia L64, Veroux P65, Giaquinta A65, Patti F65, Pulli R66, Boggia P66, Angiletta D66, Amatucci G67, Spinetti F67, Mascoli F68, Tsolaki E68, Giaquinta A69, Veroux P69, Civilini E70, Reimers B70, Setacci C71, Pogany G72, Odero A73, Accrocca F74, Bajardi G75, Takashi I76, Masayuki E76, Hidenori E77, Aidashova B78, Kospanov N78, Bakke S79, Skjelland M79, Czlonkowska A80, Kobayashi A80, Proczka R80, Dowzenko A80, Czepel W80, Polanski J80, Bialek P80, Ozkinis G81, Snoch-Ziólkiewicz M81, Gabriel M81, Stanisic M81, Iwanowski W82, Andziak P83, Gonçalves FB84, Starodubtsev V85, Ignatenko P85, Karpenko A85, Radak D86, Aleksic N86, Sagic D86, Davidovic L87, Koncar I87, Tomic I87, Colic M87, Bartkoy D88, Rusnak F88, Gaspirini M89, Praczek P89, Milosevic Z89, Flis V90, Bergauer A90, Kobilica N90, Miksic K90, Matela J90, Blanco E91, Guerra M91, Riambau V92, Gillgren P93, Skioldebrand C93, Nymen N93, Berg B93, Delle M93, Formgren J93, Kally TB93, Qvarfordt P94, Plate G94, Pärson H94, Lindgren H94, Bjorses K95, Gottsäter A95, Warvsten M95, Kristmundsson T95, Forssell C95, Malina M95, Holst J95, Kuhme T95, Sonesson B95, Lindblad B95, Kolbel T95, Acosta S95, Bonati L96, Traenka C96, Mueller M96, Lattman T96, Wasner M96, Mujagic E96, Von Hessling A96, Isaak A96, Stierli P96, Eugster T96, Mariani L96, Stippich C96, Wolff T96, Kahles T97, de Borst GJ98, Toorop R98, Moll F98, Lo R98, Meershoek A98, Jahrome AK99, Vos AWF99, Schuiling W99, Keunen R100, Reijnen M101, Macsweeney S102, McConachie N102, Southam A102, Stansby G103, Lees T103, Lambert D103, Clarke M103, Wyatt M103, Kappadath S103, Wales L103, Jackson R103, Raudonaitis A103, MacDonald S103, Dunlop P104, Brown A104, Vetrivel S104, Bajoriene M105, Gopi R105, McCollum C106, Wolowczyk L106, Ghosh J106, Seriki D106, Ashleigh R106, Butterfield J106, Welch M106, Smyth JV107, Briley D108, Schulz U108, Perkins J108, Hands L108, Kuker W108, Darby C108, Handa A108, Sekaran L109, Poskitt K110, Bulbulia R110, Morrison J110, Guyler P111, Grunwald I111, Brown J111, Jakeways M111, Tysoe S111, Hargroves D112, Gunathilagan G112, Insall R112, Senaratne J112, Beard J113, Cleveland T113, Nawaz S113, Lonsdale R113, Turner D113, Gaines P113, Nair R113, Chetter I114, Robinson G114, Akomolafe B114, Hatfield J114, Saastamoinen K115, Crinnion J115, Egun AA116, Thomas J116, Drinkwater S116, D'Souza S116, Thomson G116, Gregory B116, Babu S117, Ashley S117, Joseph T118, Gibbs R119, Tebit G120, Mehrzad A120, Enevoldson P121, Mendalow D122, Parry A123, Tervitt G124, Clifton A125, Nazzel M126, Bulbulia R127, Halliday A128, Peto R127, Pan H127, Potter J, Halliday A, Bullbulia R, Peto R, Bonati L, Pan H, Mihaylova B, Flather M, Eckstein HH, Mansfield A, Simpson D, Thomas D, Gray W, Farrell B, Davies C, Rahimi K, Gough M, Cao P, MacDonald S, Rothwell P, Belli A, Rahimi K, Mafham M, Herrington W, Sandercock P, Gray R, Shearman C, Molyneux A, Gray A, Mihaylova B, Clarke A, Sneade M, Tully L, Brudlo W, Lay M, Munday A, Berry C, Tochlin S, Cox J, Kurien R, Chester J.

Author information

1
Nuffield Department of Surgical Sciences, University of Oxford, Level 6 John Radcliffe Hospital, Oxford OX3 9DU, UK; Department of Vascular Surgery, University Medical Center Utrecht, PO Box 85500, Utrecht, The Netherlands.
2
Nuffield Department of Surgical Sciences, University of Oxford, Level 6 John Radcliffe Hospital, Oxford OX3 9DU, UK. Electronic address: alison.halliday@nds.ox.ac.uk.
3
Department of Vascular Surgery, University Medical Center Utrecht, PO Box 85500, Utrecht, The Netherlands.
4
Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, UK.
5
Department of Surgery, Istituto Auxologico Italiano IRCCS, Via Mercalli 30, 20122 Milan, Italy.
6
Department of Neurology and Stroke Center, University Hospital Basel, CH-4031 Basel, Switzerland.
7
Department of Vascular Surgery, Policlinico di Monza, Via Amati 111, 20900 Monza, Italy.
8
Medical University of Innsbruck, Austria.
9
University Hospital of Antwerp, Belgium.
10
Universitair Ziekenhuis Gent, Belgium.
11
Centre Hospitalier De Mouscron, Belgium.
12
Centre Hospitalier Régional de la Citadelle, Belgium.
13
Cliniques Universitaires St-Luc, Belgium.
14
A.Z St Blasius, Belgium.
15
University of Sao Paulo (HCFMUSP), Brazil.
16
Sveta Marina Hospital, Bulgaria.
17
Foothills Medical Centre, Canada.
18
Peking Union Medical College Hospital, China.
19
University Hospital Merkur, Croatia.
20
Hospital Ceské Budejovice, Czech Republic.
21
St Anne's University Hospital Brno, Czech Republic.
22
Regional Hospital Liberec, Czech Republic.
23
University Hospital Ostrava Poruba, Czech Republic.
24
Central Military Hospital, Czech Republic.
25
Kasr Alaini University Hospital, Egypt.
26
East Tallinn Central Hospital, Estonia.
27
Henri Mondor Hospital, France.
28
St. Joseph Hospital, France.
29
Centre de Consultation Cardiovasculaire, France.
30
Universitätsklinikum Hamburg-Eppendorf, Germany.
31
Städtisches Klinikum Karlsruhe, Germany.
32
Klinikum rechts der Isar derTechnischen Universität, Muenchen, Germany.
33
University Hospital of Jena, Germany.
34
University of Leipzig, Germany.
35
University of Dresden 'Carl-Gustav-Carus', Germany.
36
Hegau-Bodensee-Klinikum, Germany.
37
St Franziskus-Hospital Münster GmbH, Germany.
38
Park Hospital, Germany.
39
Pius Hospital, Germany.
40
University Hospital of Larissa, Greece.
41
Dept. of Vascular Surgery, Attikon University Hospital, Greece.
42
Democritus University Hospital Thrace, Greece.
43
IASO Hospital, Greece.
44
General Hospital of Athens 'Evagelismos', Greece.
45
Vascular Unit - 3rd Surgical Department, Greece.
46
Albert Szent-Györgyi Medical Centre, Hungary.
47
Semmelweis Medical University, Hungary.
48
St James Hospital, Ireland.
49
Rambam Medical Centre, Israel.
50
Istituto Auxologico Italiano, Italy.
51
Nuovo Ospedale Civile Sant' Agostino Estense, Italy.
52
Santa Maria Hospital, Italy.
53
Umberto I- ASO Mauriziano, Italy.
54
Vascular Endovascular Unit of Perugia, Italy.
55
Circolo University Hospital, Italy.
56
IRCCS Policlinico San Donato, Italy.
57
University of Bologna, Italy.
58
Mirano Hospital, Italy.
59
IRCCS San Martino, Italy.
60
Ospedale San Francesco di Nuoro, Italy.
61
San Giacomo Hospital, Italy.
62
A.C.O. San Fillippo Neri, Italy.
63
San Giovanni Di Dio, Italy.
64
University La Sapienza, Italy.
65
Policlinico Catania, Italy.
66
University of Bari, Italy.
67
Azienda Ospedaliera S.G Moscati, Italy.
68
St. Anna University Hospital Ferrara, Italy.
69
Cefalù Fondazione Istituto G. Giglio, Italy.
70
Istituto Clinico Humanities eIRCCS, Italy.
71
Policlinico Santa Maria Alle Scotte, Italy.
72
San Camillo Forlanini, Italy.
73
IRCCS Polinico San Matteo, Italy.
74
San Paolo Hospital, Italy.
75
Universita' Degli Studi Di Palermo, Italy.
76
Sendai Medical Centre, Japan.
77
Kohnan Hospital, Japan.
78
National Scientific Centre of Surgery named after A.N. Syzgan, Kazakhstan.
79
Rikshospitalet University Hospital, Norway.
80
Medical University Hospital of Warsaw, Poland.
81
Poznan University of Medical Sciences, Poland.
82
Regional Specialist Hospital, Poland.
83
Central Hospital Internal Affairs & Admin Ministry, Poland.
84
Hospital de Santa Marta, Portugal.
85
Novosibirsk Research Institute of Circulation Pathology, Russia.
86
Dedinje Cardiovascular Unit, Serbia.
87
Serbian Clinical Centre, Serbia.
88
Institute of Medical Sciences, Slovak Republic.
89
Izola General Hospital, Slovenia.
90
Teaching Hospital Maribor, Slovenia.
91
Guadalajara Hospital, Spain.
92
Hospital Clinic 1 Provincial De Barcelona, Spain.
93
Sodersjukhuset, Sweden.
94
Lasarettet Helsingborg, Sweden.
95
Malmo Vascular Centre, Sweden.
96
University of Basel, Switzerland.
97
Cantonal Hospital Aarau, Switzerland.
98
University Medical Center Utrecht, The Netherlands.
99
MCL Leeuwarden, The Netherlands.
100
Haga Ziekenhuis, The Netherlands.
101
Rijnstate Hospital, The Netherlands.
102
Nottingham University Hospital, United Kingdom.
103
Freeman Hospital, United Kingdom.
104
Sunderland Royal Hospital, United Kingdom.
105
Great Western Hospital, United Kingdom.
106
Wythenshawe Hospital, United Kingdom.
107
Manchester Royal Infirmary, United Kingdom.
108
John Radcliffe Hospital, United Kingdom.
109
Luton & Dunstable Hospital, United Kingdom.
110
Cheltenham General Hospital, United Kingdom.
111
Southend University Hospital, United Kingdom.
112
Kent and Canterbury Hospital, United Kingdom.
113
Sheffield Vascular Institute, United Kingdom.
114
Hull Royal Infirmary, United Kingdom.
115
The Royal London Hospital, United Kingdom.
116
The Royal Preston Hospital, United Kingdom.
117
Derriford Hospital, United Kingdom.
118
North Cumbria University Hospital, United Kingdom.
119
St Mary's Hospital, United Kingdom.
120
Bishop Auckland Hospital, United Kingdom.
121
Walton Centre, United Kingdom.
122
Royal Victoria Infirmary, United Kingdom.
123
James Cook Hospital, United Kingdom.
124
University Hospital of North Durham, United Kingdom.
125
St George's Hospital, United Kingdom.
126
University of Toledo, USA.
127
CTSU, Oxford, UK.
128
University of Oxford, UK.

Abstract

OBJECTIVE/BACKGROUND:

Several plaque and lesion characteristics have been associated with an increased risk for procedural stroke during or shortly after carotid artery stenting (CAS). While technical advancements in stent design and cerebral protection devices (CPD) may help reduce the procedural stroke risk, and anatomy remains important, tailoring stenting procedures according to plaque and lesion characteristics might be a useful strategy in reducing stroke associated with CAS. In this descriptive report of the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), it was assessed whether choice for stent and use or type of CPD was influenced by plaque and lesion characteristics.

METHODS:

Trial patients who underwent CAS between 2008 and 2015 were included in this study. Chi-square statistics were used to study the effects of plaque echolucency, ipsilateral preocclusive disease (90-99%), and contralateral high-grade stenosis (>50%) or occlusion of the carotid artery on interventionalists' choice for stent and CPD. Differences in treatment preference between specialties were also analysed.

RESULTS:

In this study, 831 patients from 88 ACST-2 centres were included. Almost all procedures were performed by either interventional radiologists (50%) or vascular surgeons (45%). Plaque echolucency, ipsilateral preocclusive disease (90-99%), and significant contralateral stenosis (>50%) or occlusion did not affect the choice of stent or either the use of cerebral protection and type of CPD employed (i.e., filter/flow reversal). Vascular surgeons used a CPD significantly more often than interventional radiologists (98.6% vs. 76.3%; p < .001), but this choice did not appear to be dependent on patient characteristics.

CONCLUSION:

In ACST-2, plaque characteristics and severity of stenosis did not primarily determine interventionalists' choice of stent or use or type of CPD, suggesting that other factors, such as vascular anatomy or personal and centre preference, may be more important. Stent and CPD use was highly heterogeneous among participating European centres.

KEYWORDS:

Carotid artery stenosis; Carotid artery stenting; Cerebral protection devices; Plaque echolucency; Randomized controlled trial; Stent design

PMID:
28291675
DOI:
10.1016/j.ejvs.2016.12.034
[Indexed for MEDLINE]
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