Embolic protection devices for carotid artery stenting: better results than stenting without protection?

Zahn, Ralf; Mark, Bernd; Niedermaier, Nikolaj; Zeymer, Uwe; Limbourg, P; Ischinger, Thomas; Haerten, K; Hauptmann, Karl Eugen; Leitner, Enz-Rüdiger von; Kasper, Wolfgang; Tebbe, Ulrich; Senges, Jochen

doi:10.1016/j.ehj.2004.06.018

Cited by 103 publications

(36 citation statements)

References 26 publications

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“…1,[11][12][13] However, this association has not been consistently reported with other studies showing no significant difference. 8,14 -17 Thus, the observed borderline significance between presence of clinical symptoms and periprocedural complications after CAS is within the range of the published literature.…”

Section: Discussioncontrasting

confidence: 41%

Risk Score for Peri-Interventional Complications of Carotid Artery Stenting

Hofmann

Niessner

Kypta

et al. 2006

Stroke

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Background and Purpose-Routinely available independent risk factors for the peri-interventional outcome of patients undergoing elective carotid artery stenting (CAS) are lacking. The rationale of the study was to create a risk score identifying high-risk patients. Methods-We prospectively enrolled 606 consecutive patients assigned to CAS at a secondary care hospital. Various biochemical, clinical, and lesion-related risk factors were prospectively defined. The primary end point reflecting periprocedural complications encompassed minor and major stroke, nonfatal myocardial infarction and all-cause mortality within 30 days. Results-Three percent of patients (nϭ18) experienced a nonfatal minor (nϭ13) or major (nϭ5) stroke. 1.3% of patients (nϭ8) died from fatal stroke (nϭ4) or other causes (nϭ4). No myocardial infarction was observed within 30 days after stenting. Multivariable analysis revealed diabetes mellitus with inadequate glycemic control (HbA 1c Ͼ7%), age Ն80 years, ulceration of the carotid artery stenosis, and a contralateral stenosis Ն50% as independent risk factors. A risk score formed with these variables showed a superior predictive value (C-statisticϭ0.73) compared with single risk factors. The presence of 2 or more of these risk factors identified patients with a risk of 11% for a periprocedural complication compared with 2% in patients with a score of 0 or 1. Conclusions-In patients undergoing elective CAS, a risk score based on routinely accessible variables was able to identify patients at high-risk for atherothrombotic events and all-cause death within 30 days after the intervention.

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Section: Discussioncontrasting

confidence: 41%

Risk Score for Peri-Interventional Complications of Carotid Artery Stenting

Hofmann

Niessner

Kypta

et al. 2006

Stroke

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“…Cerebral protection and relevant devices, the type of stenting, and the ultrasonography/imaging profile of the stenosis and plaque are all issues deserving adequate discussion, although until now no positions, except those on cerebral protection, are sufficiently supported by the evidence. On this point, current evidence supports the notion that stenting procedures are less prone to periprocedural risks when adequate cerebral protection is applied with a device the interventionist is familiar with and is an expert trained well in its use[46,47,48,49,50,51]. However, this statement is supported essentially by case series, some of which are quite large but probably not bias free [52].…”

Section: Cas: Acceptable Complication Rates and Risk Certificationmentioning

confidence: 81%

Carotid Artery Stenting: Second Consensus Document of the ICCS/ISO-SPREAD Joint Committee

et al. 2014

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Background: A major debate in cerebrovascular medicine today is over the choice of the best treatment to implement for stenosis of the carotid artery. Carotid artery stenting is a less invasive technique than endarterectomy for the treatment of carotid stenosis, and is becoming more widely performed, particularly on patients with carotid artery stenosis who present also with comorbidities. To address the aspects related to the use of carotid artery stenting, an Italian multidisciplinary task force comprising the most representative scientific societies concerned with carotid artery disease was set up to provide neurologists, radiologists, cardiologists, vascular surgeons, and all those involved in stroke prevention and treatment with an updated, evidence-based consensus document. Summary: The task force followed a structured methodology to assess the literature on carotid stenosis in order to provide a summary of the main issues related to carotid artery stenting, including the definition of the grade of symptomatic carotid artery stenosis, indications for intervening on the carotid artery stenosis, establishing whether to perform either a surgical or an endovascular procedure, the training, credentialization, and competency needed by physicians to perform carotid artery stenting, acceptable complication rates and risk certification for carotid artery stenting, management of stented patients, durability of carotid artery stenting, and future tasks. Here, we outline the main findings of this effort. Key Messages: As for any guideline or consensus statement, each point is valid as long as the evidence on which it is based remains up to date. In a fast-evolving field of medicine such as that of carotid artery stenosis management, and in particular carotid artery stenting, the stimulation of continuous and fruitful discussion among all professionals involved is mandatory. We hope that this document may provide a standardized basis for the application of carotid artery stenting as implemented today.

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“…For example, a large (n ϭ 1,483 patients), multicenter (n ϭ 26 hospitals), randomized study comparing CAS with vs. without EPDs demonstrated that, compared with non-use, the use of EPDs during CAS was associated with lower ipsilateral stroke (4.1% vs. 1.7%, respectively; P ϭ .007) and lower non-fatal stroke and death rates (4.9% vs. 2.1%, respectively; P ϭ .004). 2 Opposing results were reported in a recent prospective randomized study comparing the incidence of embolic lesions during CAS with vs. without EPDs; 3 the use of EPDs during CAS did not reduce the number of emboli (average number of embolic lesions: 6.1 vs. 6.2, respectively; P ϭ .79). 3 A possible explanation for this lack of difference may be the small size of CAS procedures included (n ϭ 36).…”

Section: Carotid Artery Stenting: a Promising Therapeutic Option For mentioning

confidence: 88%

Carotid artery stenting: a promising therapeutic option for carotid artery stenosis or a bubble about to burst?

Paraskevas

2008

Journal of Vascular Surgery

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R, et al; GIFA Investigators. Total serum cholesterol and recovery from disability among hospitalized older adults. J Gerontol A Biol Sci Med Sci 2006; 61:736-42. 3. Delgado-Rodríguez M, Medina-Cuadros M, Gómez-Ortega A, Martínez-Gallego G, Mariscal-Ortiz M, Martinez-Gonzalez MA, et al. Cholesterol and serum albumin levels as predictors of cross infection, death, and length of hospital stay. Arch Surg 2002;137:805-12. 4. Palma S, Cosano A, Mariscal M, Martínez-Gallego G, Medina-Cuadros M, Delgado-Rodríguez M. Cholesterol and serum albumin as risk factors for death in patients undergoing general surgery. Br J Surg 2007;94:369-75. 5. Heart Protection Study Collaborative Group. Randomized trial of the effects of cholesterol-lowering with simvastatin on peripheral vascular and other major vascular outcomes in 20,536 people with peripheral arterial disease and other high-risk conditions.

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Embolic protection devices for carotid artery stenting: better results than stenting without protection?

Abstract: Since 1996 there has been a steady increase in the use of PDs for CAS, with a 100% use in 2003. The use of a PD may lower the rate of ipsilateral strokes during CAS.

Cited by 103 publications

References 26 publications

Risk Score for Peri-Interventional Complications of Carotid Artery Stenting

Risk Score for Peri-Interventional Complications of Carotid Artery Stenting

Carotid Artery Stenting: Second Consensus Document of the ICCS/ISO-SPREAD Joint Committee

Carotid artery stenting: a promising therapeutic option for carotid artery stenosis or a bubble about to burst?

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