Feasibility, safety, and early outcomes of direct carotid artery stent implantation with use of the FilterWire EZ™ Embolic Protection System

Abstract

Direct carotid stenting with FilterWire EZ Embolic Protection System is feasible and safe. Short-term results with respect to neurological events are acceptable.

Carotid Revascularization: A Systematic Review of the Evidence

“…Seven trials stratified the results according to whether patients were symptomatic . The pooled incidence rate of the periprocedural composite end‐point of stroke, MI or death from selected prospective clinical trials was 5.59% (95% one‐sided CI upper limit: 5.99%) ranging from 1.4% reported by Veselka et al, to 8.26% reported by ARCHER . This rate is noninferior to the OPC + delta (6.3 + 3.0% or 9.3%) reported by CASES‐PMS (P < 0.001).…”

“…The periprocedural period was defined as the first 30 days postprocedure. Table displays the periprocedural outcomes of interest (stroke, MI, death, and composite end‐point of stroke, MI or death) in these trials . Seven trials stratified the results according to whether patients were symptomatic .…”

Comparison of mid-term outcomes of carotid artery stenting for moderate versus critical stenosis

“…Although no randomized data are available, we feel that closed cell designed stents, direct stent implantation without previous dilation and use of appropriate protective embolic devices are the most important factors improving the early postprocedural outcome of treated patients [5, 6]. Furthermore, the proper selection of patients including a thorough assessment of the overall clinical risk also plays an important role in the indication of CAS.…”

“…A bolus of heparin (5,000-10,000 IU) was administered at the beginning of CAS to maintain an activation clotting time of 250-300 s. The type of stent as well as the type of embolic protection device was chosen at the discretion of the primary operator (J.V.). Our approach to CAS was performed as described elsewhere [5, 6]. One of 3 filter devices was used: Filter Wire EZ (Boston Scientific, Mountain View, CA, USA), Angioguard (Cordis, Johnson and Johnson, Miami, FL, USA) or Defender (Medtronic, Minneapolis, MN, USA).…”

“…On the other hand, severe stenoses (≥ 80%) are probably associated with an increased risk of stroke of 4-5% and warrant much more aggressive revascularization [1, 2]. Carotid artery stenting (CAS) is the method of choice for carotid artery revascularization mainly in patients at high risk for surgical endarterectomy [3–6]. However, outcomes of CAS are significantly influenced by anatomical considerations and a good post-procedural prognosis is at least partially determined by the selection of optimal patients who can maximally benefit from the chosen therapeutic alternative.…”