Embolic protection devices for carotid artery stenting: Better results than stenting without protection

Zahn, R.; Mark, Bernd; Niedermaier, Nikolaj

doi:10.1016/j.accreview.2004.11.054

Cited by 30 publications

(38 citation statements)

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“…4,6,9,14,15 This contrasts with carotid endarterectomy, in which no correlation between acute complications and age was found in a meta-analysis of randomized trials comparing medical treatment and carotid endarterectomy. 16 Although it cannot be ruled out that the lack of an age effect in this meta-analysis was due at least in part to a selection bias caused by a study protocol that preferentially excluded surgical high-risk patients, it appears plausible that progressive development of atherosclerotic plaque in the aorta and the cerebrovascular territory might increase the risk of cerebral emboli in older patients in a CAS-specific way and that carotid endarterectomy may be the preferred procedure in older patients who have no general contraindications to surgery.…”

Section: Patient Characteristicsmentioning

confidence: 69%

Predictors of Death and Stroke After Carotid Angioplasty and Stenting

Theiss

Hermanek²,

Mathias³

et al. 2008

Stroke

133

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Background and Purpose-Little is known about the significance of patient characteristics, clinical indications, and technical details on the risk of carotid angioplasty and stenting (CAS). The purpose of this study was to test these parameters as to their predictive value for the peri-interventional risk of CAS. Methods-Pro-CAS is a prospective, multicenter registry of CAS. Logistic regression analysis of possible predictive factors was performed on 5341 interventions that had been entered by 25 clinical centers between July 1999 and June 2005. Results-The combined in-hospital mortality and stroke rate was 3.6%. The following were found to be significant predictors of peri-interventional stroke and death: center experience (Յ50 versus 51 to 150 versus Ն151 interventions), age, prior symptoms, primary intervention as compared with intervention for restenosis, angioplasty without stent, predilatation, and heparin dosage Ͼ5000 IU. No statistically significant result was found for year of intervention, patient volume, gender, interval between symptoms and CAS, ocular versus neurological symptoms, side of CAS, degree of stenosis of the target lesion, presence of contralateral high-degree stenosis or occlusion, method of gaining access to the carotids, stent type, and use of a protection system. Conclusions-Our findings underline the need for dedicated training and strict credentialing rules for CAS. In addition, they might help to identify subgroups of patients at differential risk for CAS and carotid endarterectomy and yield a basis for correcting risks due to differences in case mix in reports about CAS.

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Section: Patient Characteristicsmentioning

confidence: 69%

Predictors of Death and Stroke After Carotid Angioplasty and Stenting

Theiss

Hermanek²,

Mathias³

et al. 2008

Stroke

133

View full text Add to dashboard Cite

show abstract

“…All interventions were prospectively enrolled in the registry. 16 All complications occurring in the catheterization laboratory and during the in-hospital phase were prospectively documented. All data from the initiation in 1996 until the end of May 2009 were analyzed for this report.…”

Section: Methodsmentioning

confidence: 99%

“…The institutions and people who participated in the ALKK CAS Registry are listed in Zahn et al 16 The authors have no funding, financial relationships, or conflicts of interest to disclose.…”

Section: Introductionmentioning

confidence: 99%

Carotid Artery Stenting in Clinical Practice: Does Sex Matter? Results From the Carotid Artery Stenting Registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)

Werner

Zeymer

Mark

et al. 2012

Clinical Cardiology

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Background:Carotid artery stenting (CAS) is increasingly used for treatment of severe carotid artery stenosis, but only few procedural risk factors for complications of CAS are clearly defined yet. A possible impact of the patient's gender on the outcome of patients undergoing CAS has not been investigated properly and only little information about this topic is available so far.Methods:We analysed data of the German prospective, multicenter CAS Registry of the Arbeitsgemeinschaft leitende kardiologische Krankenhausärzte.Results:From July 1996 to May 2009 5130 patients underwent CAS at 35 German hospitals and were enrolled into the prospective ALKK CAS Registry. Therefrom 1443 (28.1%) patients were female. There was no significant time‐related difference in the proportion of women undergoing CAS over the years. Women undergoing CAS were significantly older than men (73 years vs. 70 years, p < 0.01) and had a longer in hospital stay in comparison to men (p < 0.01). The majority of patients treated with CAS was between 60 and 80 years of age (∼73%). No significant differences between women and men could be found regarding in‐hospital events like death (0.5% vs. 0.5%, p = 0.99), major or minor stroke (1.7% vs. 1.6%, p = 0.97; 1.0% vs. 1.6%, p = 0.12), TIA (2.8% vs. 2.6%, p = 0.64), amaurosis fugax (0.3% vs. 0.5%, p = 0.25) , intracranial bleeding (0.5% vs. 0.3%, p = 0.43), myocardial infarction (0.1% vs. 0.0%, p = 0.48) or all non‐fatal strokes and all death (3.0% vs. 3.4%, p = 0.47). 30 day event rates did not show gender related differences in the combined endpoint of the outcome of patients undergoing CAS, as well (♀ n = 31/882 [3.5%] vs. ♂ n = 109/2273 [4.8%], p = 0.12).Conclusion:Our results do not suggest any gender‐related differences in success rates and complications in CAS. In clinical practice approximately 30% of patients treated with CAS are women.The institutions and people who participated in the ALKK CAS Registry are listed in Zahn et al.16 The authors have no funding, financial relationships, or conflicts of interest to disclose.

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“…The selection of the protection devices depended on the degree of stenosis, angioanatomy of the treated carotid artery, condition of the collateral circulation, presence of contralateral carotid artery stenosis, as well as the presence of anastomotic channels between the vertebrobasilar and carotid artery systems. Fifteen patients were treated using the Parodi Anti-embolic System (ArteriA Medical Science, San Francisco, Calif., U.S.A.), 34 patients were treated using the PercuSurge GuardWire (Medtronic AVF, Santa Rosa, Calif., U.S.A.), 31 patients were treated by simultaneous temporary occlusion of the internal carotid and external carotid arteries using the PercuSurge GuardWire and Sentry Balloon catheter (Boston Scientific, Tokyo), 14 patients were treated using the Naviballoon (Kaneka Medics, Tokyo), and 4 patients were treated with the use of a commercially available filter Mint Catch (Century Medical, Tokyo 2,11,35) were explained to the patients and informed consent was obtained.…”

Section: Methodsmentioning

confidence: 99%

“…8,32) Although cerebral protection devices have been developed and are widely used to prevent periprocedural cerebral embolization, their application may result in additional complications. 9,20) Cerebral ischemia can be significantly reduced by using protected CAS compared to unprotected procedures, 8,35) whereas favorable outcomes have been reported with unprotected CAS and most of the neurological complications could not have been prevented with protection devices. 25) Cerebral protection can be achieved by different devices including filter embolic protection devices, distal balloon occlusion devices, and proximal flow reverse protection devices.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Ischemic Lesions Detected With Diffusion-Weighted Magnetic Resonance Imaging After Carotid Artery Stenting: Comparison of Several Anti-embolic Protection Devices

Taha

Maeda

Sakaida

et al. 2009

Neurol. Med. Chir.(Tokyo)

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Distal embolism is an important periprocedural technical complication with carotid angioplasty and carotid artery stenting (CAS). We evaluated the safety and efficacy of protection devices used during CAS by detecting new cerebral ischemic lesions using diffusion-weighted magnetic resonance imaging in 95 patients who underwent 98 CAS procedures: 34 using single PercuSurge GuardWire, 31 using double balloon protection, 15 using proximal flow reverse protection devices, 14 using Naviballoon, and 4 using filter anti-embolic devices. Diffusion-weighted imaging was performed preoperatively and postoperatively to evaluate the presence of any new embolic cerebral lesions. Postoperative diffusionweighted imaging revealed 117 new ischemic lesions. Three patients had new ischemic stroke, two minor and one major, all ipsilateral to the treated carotid artery. The remaining patients had clinically silent ischemia. The incidence of new embolic lesions was lower using the proximal flow reverse protection device than with the double balloon protection (33% vs. 48.4%), but the volume of ipsilateral new ischemic lesions per patient was 136.6 mm 3 vs. 86.9 mm 3 , respectively. Neuroprotection with Naviballoon yielded ipsilateral lesions of large volume (86.6 mm 3 ) and higher number (5.7 lesions per patient) than using the filter anti-embolic device (34.8 mm 3 and 1 lesion per patient). New cerebral ischemic lesions after neuroprotected CAS are usually silent. The lower incidence of distal ischemia using proximal flow reverse and double balloon protection devices is limited by the larger volume and higher number of ischemic lesions.

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Embolic protection devices for carotid artery stenting: Better results than stenting without protection

Cited by 30 publications

References 0 publications

Predictors of Death and Stroke After Carotid Angioplasty and Stenting

Predictors of Death and Stroke After Carotid Angioplasty and Stenting

Carotid Artery Stenting in Clinical Practice: Does Sex Matter? Results From the Carotid Artery Stenting Registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)

Cerebral Ischemic Lesions Detected With Diffusion-Weighted Magnetic Resonance Imaging After Carotid Artery Stenting: Comparison of Several Anti-embolic Protection Devices

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