Use Of Embolic Protection Device Research Articles

Use of an embolic protection device during carotid artery stenting is associated with lower periprocedural risk

ObjectiveTo investigate associations between individual embolic protection device (EPD) use and respective center policy with periprocedural outcomes after carotid artery stenting (CAS).MethodsThis analysis is based on the nationwide German statutory...

Safety and efficacy of cerebral embolic protection devices in transcatheter aortic valve implantation: a meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background Stroke during Transcatheter Aortic Valve implantation (TAVI) is not an uncommon complication with potential devastating consequences. With the extension of TAVI to the low-risk patient, stroke prevention takes on increasing importance. The use of cerebral embolic protection device (EPD) reveals conflicting data. This meta-analysis aims to evaluate the clinical efficacy and safety of EPDs. Methods A comprehensive literature search for all studies till May 2022 reporting clinical safety and efficacy outcomes of the only EPD approved for use by the Food and Drug Administration (FDA) was performed. Study outcomes were divided based on time period - overall (up to 30 days and in-hospital) and short (≤7 days). Primary outcome was stroke - major and minor. Secondary outcomes included transient ischaemic attack (TIA), mortality, acute kidney injury (AKI), major vascular and bleeding complications. Results A total of 12 studies involving 288531 patients were analysed, which included 3 randomised controlled trials (RCTs), 7 propensity-matched and 2 cohort studies. Regarding overall outcomes, significant differences were noted for mortality (OR 0.59 [0.42-0.84], p=0.0036) and major stroke (OR 0.40 [0.18-0.91], p=0.028) (Fig 1). No significant differences were noted for all stroke (p=0.058), minor stroke (p=0.32), TIA (p=0.49), AKI (p=0.17), major vascular complications (p=0.40) and major bleeding complications (p=0.11). There was significant heterogeneity across the studies for mortality (p=0.032) and all stroke (p=0.009). In the subgroup analysis of studies reporting ≤7 days outcomes (n=5), EPDs showed significantly lower rates of all stroke (0.33 [95% CI 0.19-0.56], p=<0.0001), major stroke (0.19 [0.08-0.48], p=0.0004) and major bleeding complications (OR 0.29 [0.10-0.79], p=0.016), but no significant differences for mortality (p=0.67) and minor stroke (p=0.070). There was no significant heterogeneity across the studies (all p>0.05) Conclusions In this meta-analysis including non-randomised studies, the use of EPDs was associated with lower mortality and major stroke rates, although significant heterogeneity was noted for the studies reporting mortality. Further ongoing larger scale RCTs will further clarify these results.

Carotid artery stenting with or without distal filter-type embolic protection device: A single center experience

Aim: To share the data of patients who underwent carotid artery stenting (CAS) with or without a distal filter-type (DF) embolic protection device (EPD) in our clinic and our own experiences. Method: The files of patients who underwent CAS in our clinic between November 2019 and January 2021 were reviewed retrospectively. Patients with >50% stenosis in symptomatic patients, >70% in asymptomatic patients, and those who had CAS at least 48 hours after the last symptom were included. Patients who underwent acute CAS and were treated for restenosis after carotid stent or endarterectomy were excluded from the study. Thirty-five patients who used DF in CAS procedure and 16 patients who did not use EPD were included in the study. Results: No significant difference was found between the two groups in terms of new neurological and cardiac vascular events (p=0.58). A new ischemic lesion was detected in diffusion MRI in 76.5% of the patients who underwent CAS using a DF type EPD and 81.8% of patients who underwent CAS without the use of an EPD. No significant difference was found between the detection rates of new ischemic lesions (p=0.73). Conclusions: Since we found no significant difference in neurological and cardiac vascular events between the patients who underwent CAS with and without use of DF type EPD, we suggest that CAS can be performed without the use of a DF type EPD in suitable patients to reduce the cost of the procedure.

Abstract P540: Safety of Carotid Artery Stenting Without Embolic Protection: A Single Centre Experience

Introduction: One of the most feared complications of carotid revascularization, including carotid artery stenting (CAS), is peri-procedural ischemic stroke. Several studies suggest that the use of a distal embolic protection device (EPD), as well as over-sized pre- and post-stenting balloon angioplasty, may increase the risk of dislodgement of atheromatous plaque in patients undergoing CAS. The CREST trial, that mandated the use of an EPD, had a peri-procedural ischemic stroke rate of 4.1%. We hypothesize that our technique of stenting without the use of an EPD and sub-maximal angioplasty will have a low risk of peri-procedural complications. Methods: A retrospective review was conducted of consecutive cases of ICA stenting without use of an embolic protection device between January 2012 and June 2020 at a Canadian stroke centre. Data was extracted from the patient electronic medical record and Picture Archives and Communications Systems (PACS). Both symptomatic and asymptomatic CAS cases were included. Results: A total of 220 patients were included in the study, with a median age of 70 years (range 39-93 years), and 83 patients (38%) were female. The vast majority of patients were symptomatic (216 patients [98%]). A large portion of patients had a contralateral ICA occlusion or near occlusion (56 patients [25%]). In the majority of cases, a Precise Cordis RX carotid stent (Cordis) was placed. There were four patients with peri-procedural ischemic strokes (1.8%), with two occurring 8-30 days after stenting. There was one case of acute stent occlusion associated with an ischemic stroke. Two patients (less than 1%) had hyperperfusion syndrome after CAS. Median length of stay following the procedure was one day. Conclusions: In this single centre series, the peri-procedural risks of CAS without using an EPD are low. The ischemic stroke rate is less than 2%, lower than what has been reported in large randomized controlled trials using embolic protection.

Embolic Protection Devices Are Not Associated With Lower Rates of Distal Embolization in Femoropopliteal Atherectomy

The use of an embolic protection device (EPD) in endovascular atherectomy for occlusive disease is common; however, there is still a lack of data to guide clinical practice. We examined the use of EPD during femoropopliteal atherectomy for occlusive disease in a real-world national sample.

The Use of Embolic Protection Devices during Lower Extremity Peripheral Vascular Interventions

The use of embolic protection device (EPD) during lower extremity peripheral vascular interventions (PVI) has been reported, but its impact on outcomes is unclear. The goal of this study was to assess the use and outcomes of EPDs during PVI. All PVI between 2010 and 2014 in the Vascular Study Group of New England (VSGNE) database were reviewed. The characteristics of patients and lesions treated with EPD were identified. A propensity-matched control group without EPD was selected. The outcomes of both groups were compared, and a multivariable analysis was performed. There were a total of 10,875 procedures. EPD was used in 2% of the procedures. From 2010 to 2014, EPD use significantly increased from 1.1 to 3.5% (P<0.001). Patients undergoing PVI with EPD were less likely to be white but more likely to have diabetes, chronic obstructive pulmonary disease, coronary artery disease, and history of prior PVI. After propensity matching, there were 182 procedures with EPD and 604 controls with no significant difference in risk factors. There was no difference in indication or anatomic level treated, with claudication (52.7% vs. 49.8%) being most common indication and the superficial femoral artery (65.4% vs. 62.1%), the most commonly treated artery. Patients undergoing PVI with EPD were more likely to be treated with excisional atherectomy (26.4% vs. 12.6%), whereas patients without EPD were more likely to be treated with orbital atherectomy (31.9% vs. 41.6%, P=0.017). There was no significant difference in the incidence of minor distal embolization (DE) (1.1% vs. 1.5%) or DE requiring endovascular treatment (2.8% vs. 2.6%) between the two groups, but EPD use was significantly associated with increased fluoroscopy time (P<0.001). There was no difference in technical success, patency, amputation, or mortality between the two groups. On multivariable analysis, there was no significant association between the use of EPD and patency (incidence relative risk (IRR) [95% CI]=1.1 [0.9-1.3]), amputation (IRR=0.7 [0.2-2.1]), or mortality (IRR=0.8 [0.6-1.2]). However, there was a significant difference in fluoroscopy time (mean ratio [95% CI]=1.2 [1.1-1.3]). The analysis was repeated after eliminating all procedures with DE in the EPD group (assuming that EPD use is 100% effective in preventing DE), and the results were no different. EPD use during PVI has significantly increased. Despite EPDs increasing procedural complexity and time, they do not seem to have any impact on PVI outcomes. Additional studies are needed to characterize which patients would benefit from EPDs.

The use of embolic protection device in the stenting of brachiocephalic arteries

Objective — to optimize the results of endovascular treatment of stenotic pathology of brachiocephalic arteries.&#x0D; Materials and methods. The results of surgical treatment of 112 patients, among whom there were 79 (70.5 %) men and 33 (29.5 %) women aged from 28 to 86 years with symptomatic stenotic lesions of brachiocephalic arteries treated in the neurosurgical department of the Zaporizhzhia regional hospital in the period from 2010 to 2018 were analyzed. Observations were divided into three groups depending on the localization of the defeat: internal carotid artery — 74 (66 %) cases (predominant stenosis of the mouth of the ICA (n = 71)), vertebral artery — 25 (22.4 %), a portion of the subclavian artery or brachiocephalic trunk — 13 (11.6 %). All patients underwent MRI of the brain in the preoperative period, as well as in 45 (40 %) cases of CTangiography. In all cases prior to surgery invasive angiography was performed with an assessment of the state and anatomy of the brachiocephalic and intracranial arteries, as well as the possibilities of collateral blood flow.&#x0D; Results. In the first group, which was conducted carotid stenting embolic protection device was used in 72 (97.2 %) cases. In the second group, distal protection device were used twice 2 (8 %) in the resolution of extended stenoses of the dominant vertebral artery mouth. In the third group, the distal protection device was used in 1 (7.7 %) case for stenting the critical extended stenosis of the brachiocephalic trunk with the transition to common carotid artery. Complications were noted in 9 observations. In one case there was a development of ischemic stroke, intraoperatively, in a patient with an echeloned lesion of the intracranial basin of a stenting internal carotid artery, probably against a background of hypotension of the stent developed during implantation. In 8 (7.1 %) cases the formation of the hematoma of the puncture site of the femoral artery was noted.&#x0D; Conclusions. The use of embolic protection device is mandatory in standard carotid stenting. The choice of method of protection depends on the severity of stenosis, as well as the individual features of collateral blood flow. When stenting subclavian artery, brachiocephalic trunk and vertebral artery, in some cases it is justified to use distal protection devices, the latter increases the safety of the operation.

Trials and Frontiers in Carotid Endarterectomy and Stenting.

Based on the strength of randomized trials from the 1990s, major societal guidelines recommend carotid endarterectomy (CEA) for severe (≥70%), symptomatic carotid stenosis if an operative stroke/death rate of <6% can be maintained (history and major trials in carotid revascularization are summarized in the online-only Data Supplement).1–4 Though the benefit is less evident, most guidelines also recommend consideration of CEA for 50% to 69% symptomatic stenosis.2–4 There are subtle differences in recommendations regarding carotid artery stenting (CAS) in symptomatic patients. Some guidelines stipulate that CEA should be preferred over CAS in patients with severe (≥70%) symptomatic carotid stenosis,2,5 especially if >70 years old,4 whereas others position CAS as an alternative.1,3 Though the risk of operative stroke/death is higher with CAS, major randomized clinical trials (RCTs) report event rates under the recommended 6% cutoff for both treatment modalities. Regarding asymptomatic disease, CEA is recommended for patients with stenosis ≥60% to 70% in highly selected patients as long as operative stroke/death rates <3% can be maintained.1 A predicted life expectancy of at least 3 to 5 years has also been suggested.2 The 3% threshold has been easily met by CEA cohorts in the CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial; 1.4%)6 and the ACT1 (Asymptomatic Carotid Trial; 1.7%),7 suggesting that an even lower threshold may be appropriate. Controversially, some guidelines have recommended that CAS can be considered in highly selected patients with asymptomatic carotid stenosis ≥60% to 70%,1,4,8 whereas others argue that the evidence remains insufficient.2 The lack of consensus in the management of asymptomatic carotid stenosis is reflective of an ongoing need for high-quality RCT data to guide practice. ### CEA Operative Stroke Risk and High Risk Designation Most clinical trials in carotid revascularization have focused …

Hospital Performance on Percutaneous Coronary Intervention Process and Outcomes Measures.

BackgroundThe Physician Consortium for Performance Improvement recently proposed percutaneous coronary intervention (PCI)‐specific process measures. However, information about hospital performance on these measures and the association of PCI process and outcomes measures are not available.Methods and ResultsWe linked the National Cardiovascular Data Registry (NCDR) CathPCI Registry with Medicare claims data to assess hospital performance on established PCI process measures (aspirin, thienopyridines, and statins on discharge; door‐to‐balloon time; and referral to cardiac rehabilitation), newly proposed PCI process measures (documentation of contrast dose, glomerular filtration rate, and PCI indication; appropriate indication for elective PCI; and use of embolic protection device), and a composite of all process measures. We calculated weighted pair‐wise correlations between each set of process metrics and performed weighted correlation analyses to assess the association between composite measure performance with corresponding 30‐day risk‐standardized mortality and readmission rates. We reported the variance in risk‐standardized 30‐day outcome rates explained by process measures. We analyzed 1 268 860 PCIs from 1331 hospitals. For many process measures, median hospital performance exceeded 90%. We found strong correlations between medication‐specific process measures (P<0.01) and weak correlations between hospital performance on the newly proposed and established process measures. The composite process measure explained only 1.3% and 2.0% of the observed variation in mortality and readmission rates, respectively.ConclusionsHospital performance on many PCI‐specific process measures demonstrated little opportunity for improvement and explained only a small percentage of hospital variation in 30‐day outcomes. Efforts to measure and improve hospital quality for PCI patients should focus on both process and outcome measures.

The Use of Aspiration Catheter Systems for Embolic Protection during Intracranial Vertebral Artery Angioplasty and Stenting

Background: Posterior circulation strokes comprise approximately 20-25% of all strokes of ischemic origin. Strokes affecting this area carry a significantly higher risk for subsequent stroke or death as compared to anterior circulation strokes. Embolic protection device (EPD) use for carotid artery stenosis has translated into percutaneous interventions of proximal vertebral artery (VA) stenosis. However, the use of EPDs when treating intracranial lesions has yet to be studied and may not be feasible as the vessel caliber is frequently smaller than in existing devices. Objective: The aim of this study is to describe a proximal aspiration technique used during the treatment of intracranial VA and basilar artery (BA) atherosclerotic disease. Methods: Proximal embolic protection was utilized during the treatment of intracranial VA/BA stenosis with angioplasty and stenting in patients with medically refractory disease. Results: Three patients with severe symptomatic posterior circulation stenosis refractory to medical management were treated with angioplasty and stenting utilizing proximal aspiration. Pre- and post-treatment angiograms and MRIs were compared. Treated vascular stenoses were significantly improved, without new neurological deficits or ischemic injury identified on imaging. Conclusions: The proposed technique of proximal embolic protection may help overcome the challenge of embolus propagation inherent to the treatment modality that was encountered during the treatment of intracranial VA/BA stenosis.

The use of embolic protection device in lower extremity catheter-directed thrombolysis.

The use of embolic protection device in lower extremity catheter-directed thrombolysis.

Fifteen-Year Experience With Carotid Artery Stenting (from the Carotid Artery Stenting—Registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte)

To date only sparse data are available on trends and changes in indications, patient's characteristics, and clinical outcome of patients undergoing carotid artery stenting (CAS) in clinical practice. From February 1996 to December 2010, 6,116 CAS procedures were performed in 5,976 patients at 36 hospitals within the prospective, multicenter CAS registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte. Median age of patients was 71 years, 71.6% were men; a symptomatic stenosis was treated in 50.3% and an embolic protection device (EPD) was used in 82.5% of the patients. The overall hospital mortality or stroke rate was 3.1%. Stroke or in-hospital death occurred in 4.0% in symptomatic patients and in 2.2% in asymptomatic patients. In a logistic regression model, independent predictors of in-hospital death or stroke were heart failure (odds ratio [OR] 2.03, 95% confidence interval [CI] 1.22 to 3.36, p = 0.006), symptomatic stenosis (OR 1.52, 95% CI 1.05 to 2.18, p = 0.03), and age (OR per 10 years 1.46, 95% CI 1.17 to 1.81, p <0.001). The use of an EPD was significantly associated with a lower rate of death or stroke in the registry (OR 0.45, 95% CI 0.26 to 0.78, p = 0.004). From 1996 to 2010, mean age of patients increased by 4.1 years (p <0.001), the proportion of male patients decreased from 82.4% to 70.2% (p = 0.07), the proportion of symptomatic stenoses decreased (84.6% to 24.7%, p <0.001), and the use of EPDs increased from 1.4% to 97.2% (p <0.001). Comparing 2 periods from 1996 to 2003 and 2004 to 2010, a numeric decrease in the in-hospital stroke or death rate was seen in symptomatic (4.7% vs 3.5%, p = 0.11), and in asymptomatic patients (2.9% vs 2.1%, p = 0.27) undergoing CAS, which did not reach statistical significance. In conclusion, the proportion of symptomatic carotid artery stenoses decreased significantly; EPDs established as a standard tool and a numeric decrease of in-hospital stroke or death was seen in asymptomatic and symptomatic patients undergoing CAS in clinical practice over the last 15 years.

Results of carotid angioplasty and stenting are equivalent for critical versus high-grade lesions in patients deemed high risk for carotid endarterectomy

BackgroundTo examine outcomes of carotid angioplasty and stenting (CAS) in patients with critical carotid stenosis who are deemed high risk for carotid endarterectomy. MethodsMedical records were retrospectively analyzed for patients undergoing CAS between September 2002 and March 2011 at a single institution. Patients were classified as having either critical (≥90%) or high-grade (70%–89%) carotid stenosis based on angiography. The primary composite end point was stroke, myocardial infarction, or death from any cause during the periprocedural period or any ipsilateral stroke during the follow-up period. ResultsA total of 245 patients underwent 257 CAS procedures during the study period. Fifty-one percentage (n = 130) of cases involved critical stenosis (66.2% male; mean age, 71 ± 10 y), with the remaining group (n = 127) involving high-grade stenosis (67.7% male; mean age, 71 ± 9 y). Symptomatic carotid disease was present in 25% of the critical stenosis and 31% of the high-grade stenosis groups (P = 0.33). Chronic obstructive pulmonary disease was more commonly found in the high-grade stenosis group (20% versus 8%, P = 0.01). No difference was observed between the groups relative to other baseline demographic characteristics, presence of contralateral carotid occlusion, stent diameter or length, maximum balloon diameter or length, use of embolic protection device, or procedural duration. Technical success was achieved in all cases. There was no difference in the need to predilate before the introduction of the filter or stent based on the degree of stenosis. We found no difference in the primary composite end point between the high-grade or critical stenosis groups (7.1% versus 7.7%, P = 0.74), or there were no differences between the individual components of the composite end point. Mid-term survival was similar between the two groups at a mean follow-up period of 2.4 y. ConclusionsDespite concerns regarding the potential for increased neurologic complications, our data demonstrate that patients with high-grade and critical stenosis are able to safely undergo CAS and achieve similar periprocedural outcomes and mid-term prognosis.

An Analysis of the Factors Influencing Radiation Dose and Fluoroscopic Time During Renal Artery Stent Placement

To determine the factors that affect mean absorbed dose and fluoroscopic times during renal artery stent placement. After institutional review board approval, the HI-IQ database was queried for patients undergoing renal artery stent placement only from January 2007 to June 2010. Procedures that were performed as part of other procedures such as iliac artery stents were excluded. The HI-IQ data included fluoroscopy time (f) and radiation dose (mGy). Demographic, medical history, procedural details, and advanced preprocedural renal artery stent imaging were obtained. Variables (number of stents, average body mass index , number of stents placed per year and number of years' service of an interventional physician, pre-procedural imaging, and use of embolic protection device) were analyzed using a t test after log transformation and testing for variance with an F test. A total of 134 patients (75 males, 70.6 ± 10.5 years old) underwent the placement of 177 renal artery stents (unilateral [n = 95], average stent per patient = 1.3). Mean fluoroscopy time was 15.6 minutes and mean absorbed dose to the patient was 1729 mGy. The average fluoroscopic time and absorbed dose was significantly higher with bilateral stent placement compared to unilateral placement (13.8 vs 19.7 minutes, P = .002; 1803 vs 2380 mGy, P = .03). The average fluoroscopic time was significantly higher in patients undergoing abdominal aortogram prior to renal artery selection and stent placement. The placement of more than 1 stent with an abdominal angiogram prior to renal artery stent placement results in increased fluoroscopic time and mean absorbed dose.

First clinical experience with the GARDEX EPD: a novel embolic protection device for carotid artery stenting

Carotid artery stenting (CAS) has become an alternative to carotid endarterectomy in the treatment of carotid artery disease. The use of an embolic protection device (EPD) can reduce the frequency of embolic events during CAS. Difficult vascular anatomy may complicate current generation EPD placement. This problem is addressed by a new EPD, the GARDEX System. The aim of this study was to assess the safety and performance of the GARDEX EPD during CAS. Thirty-eight patients underwent CAS with the GARDEX EPD in two medical centres. All patients were prospectively followed up for 30 days. Device performance and procedural details were collected and analysed prospectively. Vessel anatomy and lesion morphology were evaluated and stratified into a scoring system for anatomic difficulty. More than a third of the patients were considered to have difficult vascular anatomy for CAS. All enrolled patients were successfully treated. There was one (2.6%) minor periprocedural stroke and there were two (5.3%) periprocedural TIAs which resolved within 24 hours. No additional complications were noted during the 30-day follow-up period. In this first experience, CAS under cerebral protection with the GARDEX EPD was safe and feasible. Our data suggest that the use of the GARDEX EPD is simple and shows high success rates even in challenging anatomies. The role of this new device in CAS needs to be further confirmed in a larger patient population.

Embolic protection device utilization during stenting of native coronary artery lesions with large lipid core plaques as detected by near‐infrared spectroscopy

Stenting of large lipid core plaques (LCPs), as assessed by near-infrared spectroscopy (NIRS), has been associated with periprocedural myocardial infarction (MI), possibly due to distal embolization. An embolic protection device (EPD) was inserted before stenting in nine native coronary arteries with large LCP, as assessed by NIRS. Embolized material was assessed by histopathology. Mean age was 64 ± 7 years and all patients were men. The target lesion was located in the right (67%) or left anterior descending (33%) coronary artery. A filter was utilized in eight patients (89%) and proximal embolic protection in one (11%). In one patient two filters were required because the originally placed filter became obstructed with debris after initial stent placement. The mean percent angiographic stenosis prestenting and poststenting was 87% ± 9% and 2% ± 4%, respectively and final TIMI 3 flow was achieved in all patients. Embolized material was retrieved in eight of nine patients (89%) and consisted mainly of platelet and fibrin thrombi. The mean target segment lipid core burden index decreased from 395 ± 114 before stenting to 152 ± 106 after stenting (P < 0.001) and the lesion angular extent decreased from 312° ± 70° to 240° ± 90° (P = 0.07). Postprocedural MI occurred in two of nine patients (22%), in one of whom two filters were required. Use of EPDs frequently resulted in embolized material retrieval after stenting of native coronary artery lesions with large LCPs. These findings support further study of EPDs as a means to prevent poststenting MI.

Carotid stenting of asymptomatic and symptomatic carotid artery stenoses with and without the use of a distal embolic protection device

Objective The objective of this study was to evaluate the incidence of symptomatic and clinically silent emboli following carotid angioplasty and stent placement (CAS) with and without the use of an embolic protection device (EPD).Materials and methods Between January 2006 and April 2009, 76 patients with carotid stenosis underwent 79 CAS procedures (three patients had bilateral CAS). In this group, 44 of the 79 procedures were performed with an EPD, and 35 were performed without an EPD. In the EPD group, 26 treated hemispheres received pre- and post-operative diffusion-weighted MRI (DWI), and in the non-EPD group, 16 treated hemispheres received pre- and post-operative DWI.Results All 79 procedures were technically successful without significant residual stenosis. In the EPD group, there were three symptomatic ischaemic events (6.8%), and 4 of the 26 (15.4%) treated hemispheres which received MRI showed new DWI lesions. In the non-EPD group, there was one symptomatic ischaemic event (2.9%), one mortality (2.9%) due to reperfusion injury with intracranial haemorrhage, and three of the 16 (18.8%) treated hemispheres which received MRI showed new DWI lesions.Conclusions The results of this retrospective analysis do not show demonstrable benefits of reducing new DWI lesions or major/minor ischaemic events after CAS with a fi lter protection device. Further investigations with more accurate risk-analysis strategies remain necessary in hopes of selecting patients most likely to benefit from the use of an embolic protection device.

Clinical Outcomes Following Protected Carotid Artery Stenting in Symptomatic and Asymptomatic Patients

To evaluate clinical outcomes in patients undergoing carotid artery stenting (CAS) with routine use of a cerebral embolic protection device (EPD). A retrospective cohort analysis was conducted of 490 consecutive patients (365 men; mean age 70.7+/-8.5 years) who underwent CAS with EPD between January 1999 and December 2007 at 2 institutions with large referral practices. There were 163 symptomatic patients with stenosis >or=50% and 327 asymptomatic patients with >or=80% diameter stenosis treated in 536 CAS procedures. Nearly a quarter (116, 23.7%) of the cohort had diabetes. High-risk surgical features were present in 141 (28.8%): 73 (14.9%) aged >or=80 years, 25 (5.1%) with significant heart disease, 23 (4.6%) with postsurgical restenosis, and 16 (3.2%) with contralateral carotid occlusion. An EPD was successfully placed in 512 (95.5%) patients. The incidence of any stroke within 30 days was 3.3% (16/490), of which the majority (13, 2.6%) were ipsilateral [5 (1.0%) major and 8 (1.6%) minor]. The incidence of major adverse events (MAE), i.e., any stroke, death or myocardial infarction, within 30 days was 3.7% (18/490); the incidence of 30-day any stroke/death was 3.7% (18/490), while the cumulative incidence of any stroke/death at 1 year was 6.1% (30/490). In symptomatic patients, the 30-day MAE rate was 6.7% (11/163) versus 2.1% (7/237) in the asymptomatic group (p = 0.02). A subgroup analysis based on surgical risk showed that the 30-day MAE rate was similar between high-risk and non-high-risk patients [4.9% (7/144) versus 3.2% (11/346); p = 0.5]. In this large real-world cohort, CAS with routine use of EPDs was technically feasible, clinically safe, and associated with a low rate of periprocedural and 1-year events; results were similar irrespective of surgical risk.

Abstract No. 39: Comparison of outcomes for hypertensive response and renal function in patients with renal artery stenosis who underwent stent placement with and without concomitant use of embolic protection device

Abstract No. 39: Comparison of outcomes for hypertensive response and renal function in patients with renal artery stenosis who underwent stent placement with and without concomitant use of embolic protection device

Prevention of coronary slow flow/no reflow during percutaneous coronary intervention by the use of embolic protection device, ‘Filtrap’

A 68year-old man underwent percutaneous coronary intervention (PCI). A 64 multi-slice computed tomography (MSCT) demonstrated a non-calcified plaque with positive remodeling. Intravascular ultrasound showed severe attenuation which suggested high risk of coronary no reflow during PCI. In order to avoid this, we used an embolic protection device, Filtrap. Immediately after deployment of a Taxus stent, ST-elevation with chest pain and coronary no reflow appeared. After retrieval of the Filtrap device, ST-elevation and no reflow disappeared. The filter was filled with yellow materials. This case suggests two things: that 64 MSCT can detect coronary plaque with high-risk of coronary no reflow during PCI; and that using a Filtrap device can effectively prevent the coronary no reflow during PCI.