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JACC Cardiovasc Interv. 2017 Jun 26;10(12):1257-1265. doi: 10.1016/j.jcin.2017.03.032.

The Use of Embolic Protection Devices Is Associated With a Lower Stroke and Death Rate After Carotid Stenting.

Author information

1
Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
2
AQUA-Institut für Angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany.
3
Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. Electronic address: gefaesschirurgie@mri.tum.de.

Abstract

OBJECTIVES:

The aim of this study was to analyze the association between intraprocedural and periprocedural variables and in-hospital stroke or death rate after carotid artery stenting.

BACKGROUND:

In Germany, all open surgical and endovascular procedures on the extracranial carotid artery must be documented in a statutory nationwide quality assurance database.

METHODS:

A total of 13,086 carotid artery stenting procedures for asymptomatic (63.9%) or symptomatic carotid stenosis (mean age 69.7 years, 69.7% men) between 2009 and 2014 were recorded. The following variables were analyzed: stent design, stent material, neurophysiological monitoring, periprocedural antiplatelet medication, and use of an embolic protection device. The primary outcome was in-hospital stroke or death. Major stroke or death, any stroke, and death, all until discharge, were secondary outcomes. Adjusted relative risks (RRs) were assessed using multilevel multivariable regression analyses.

RESULTS:

The primary outcome occurred in 2.4% of the population (1.7% in asymptomatic and 3.7% in symptomatic patients). The multivariable analysis showed an independent association between the use of an embolic protection device and lower in-hospital rates of stroke or death (adjusted RR: 0.65; 95% confidence interval [CI]: 0.50 to 0.85), major stroke or death (adjusted RR: 0.60; 95% CI: 0.43 to 0.84), and stroke (adjusted RR: 0.57; 95% CI: 0.43 to 0.77). Regarding the occurrence of in-hospital death, there was no significant association (adjusted RR: 0.78; 95% CI: 0.46 to 1.35). None of the outcomes was associated with stent design, stent material, neurophysiological monitoring, or antiplatelet medication.

CONCLUSIONS:

The use of an embolic protection device was independently associated with lower in-hospital risk for stroke or death, major stroke or death, and stroke.

KEYWORDS:

carotid artery disease; carotid artery stenting; death; embolic protection device; stroke

PMID:
28641848
DOI:
10.1016/j.jcin.2017.03.032
[Indexed for MEDLINE]
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