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Carotid stenting and bivalirudin with and without vascular closure: 3‐year analysis of procedural outcomes
Author(s) -
Schneider Laurence M.,
Polena Sotir,
Roubin Gary,
Iyer Sriram,
Vitek Jiri,
Panagopoulos Georgia,
Mussap Christian J.,
Vitellas Michael,
Mahdavi Ramyar,
Brennan Christina
Publication year - 2010
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.22322
Subject(s) - medicine , bivalirudin , carotid stenting , direct thrombin inhibitor , vascular closure device , cardiology , anesthesia , incidence (geometry) , percutaneous , percutaneous coronary intervention , surgery , warfarin , carotid arteries , atrial fibrillation , myocardial infarction , physics , carotid endarterectomy , dabigatran , optics
Objectives : The purpose of this study was to examine the outcome of carotid stenting using bivalirudin and the influence of vascular closure devices (VCD) on the incidence and severity of peri‐procedural hypotension. Background : Bivalirudin, a short‐acting direct thrombin inhibitor, has been shown to be an effective anticoagulant in coronary interventions, with less risk of bleeding compared with heparin. Routine use of VCD has become the standard of care, facilitating patient ambulation after percutaneous carotid and coronary interventions. The combined use of these two therapies (bivalirudin and VCD) may improve outcomes in carotid interventions where prolonged patient immobilization may exacerbate hypotension following stenting. Methods : A total of 514 patients underwent 536 carotid stenting procedures in the 3‐year period from September 2004 to September 2007. All patients received adjunctive bivalirudin, with and without VCD. This cohort was analyzed for peri‐procedural and 30‐day clinical outcomes and length of hospitalization. Results : Thirty‐day stroke and death rate was 1.7%. A total of 83 patients (15.4%) experienced intra‐ or post‐procedural hypotension (systolic BP < 80 mm Hg). There were four (0.7%) major bleeding complications requiring transfusion, and length of stay was delayed more than 24 hr in five patients (0.93%), all of whom were in the manual compression group. Conclusions : This was a negative study, with no significant difference on prolonged hypotensive events in patients with vascular closure device and bivalirudin, compared with those with manual compression and bivalirudin. Vascular closure devices were safe and effective with a low incidence of complications. In carotid artery stenting, bivalirudin is safe with low incidence of major bleeding and acceptable 30‐day adverse event rates (stroke and death). © 2010 Wiley‐Liss, Inc.