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Comparison of devices used in carotid artery stenting: A vascular quality initiative analysis of commonly used carotid stents and embolic protection devices
Author(s) -
Dhillon Ashwat S.,
Li Sisi,
Lewinger Juan Pablo,
Shavelle David M.,
Matthews Ray V.,
Clavijo Leonardo C.,
Weaver Fred A.,
Garg Parveen
Publication year - 2018
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.27646
Subject(s) - medicine , stroke (engine) , carotid stenting , cardiology , stent , revascularization , stenosis , carotid artery disease , coronary artery disease , surgery , carotid endarterectomy , myocardial infarction , mechanical engineering , engineering
Background Data regarding efficacy of various stent and embolic protection device (EPD) combinations to prevent stroke during carotid artery stenting (CAS) is limited. We compared post‐procedure inpatient neurologic outcomes across various carotid stent‐EPD platforms recorded in the Vascular Quality Initiative (VQI) registry. Methods We analyzed 13,786 consecutive CAS procedures in the VQI registry performed between January 1, 2005 and December 31, 2015. The most commonly used stent‐EPD combinations ( n = 5407) were included in the analysis. Post‐procedure inpatient neurologic outcomes included (1) ipsilateral stroke/transient ischemic attack (TIA) and (2) any stroke/TIA. Multivariate generalized estimating equation regression analysis was performed, adjusting for age, sex, tobacco use, coronary artery disease, congestive heart failure, prior stroke/TIA, hypertension, history of carotid revascularization, and presence of a second ipsilateral stenosis >70%, to determine whether risk of outcomes differed according to device. Results Of 13,786 CAS procedures, Xact‐Emboshield ( n = 2,438, 17.6%), Precise‐Angioguard ( n = 1,480, 10.7%), Acculink‐Accunet ( n = 829, 6.01%), and Acculink‐Emboshield ( n = 660, 4.8%) were the most commonly used combinations, accounting for a total of 5,407 procedures. Inpatient event rates for ipsilateral stroke/TIA and any stroke/TIA were 1.9 and 2.7% in the Accunet‐Acculink, 3.0 and 3.2% in Acculink‐Emboshield, 3.2 and 4.1% in Precise‐Angioguard and 2.2 and 3.0% in Xact‐Emboshield. There was no evidence of difference in risk of ipsilateral stroke/TIA or any stroke/TIA across device combinations ( P = 0.15 and P = 0.16, respectively). Conclusion CAS with current carotid stent‐EPD combinations is associated with low rates of inpatient stroke/TIA. There is no statistically significant difference in rates of inpatient stroke/TIA across device combinations.