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Proximal embolic protection during CAS yields low in-hospital stroke, death rate
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During carotid artery stenting, use of a proximal embolic protection device or a distal filter embolic protection device yielded similarly low rates of in-hospital stroke and death.
Researchers compared outcomes between embolic protection devices in 10,246 patients with carotid stenosis enrolled in the CARE Registry who underwent carotid artery stenting (CAS) at 184 hospitals from January 2009 to March 2013. A proximal embolic protection device was used in 590 patients and a distal filter embolic protection device in 9,656.
“In this first large, multicenter, comparative-effectiveness analysis of proximal vs. distal embolic protection for CAS, we found that [proximal devices] have been used in a small minority of U.S. patients,” Jay Giri, MD, MPH, from the cardiovascular medicine division at University of Pennsylvania Perelman School of Medicine, and colleagues wrote.
Jay Giri
Compared with distal filter embolic protection devices, patients who received proximal embolic protection devices had higher rates of symptomatic lesion status (46.8% vs. 39.7%; P < .001), atrial fibrillation or flutter (16.1% vs. 13%; P = .03) and neurological event history (51.2% vs. 46.6%; P = .03).
The primary outcome was incidence of in-hospital major adverse events, defined as a composite of stroke and death. The researchers reported no significant difference in in-hospital stroke/death between patients who received proximal or distal filter embolic protection devices in unadjusted analyses (1.5% vs. 2.4%, respectively; P = .16) and propensity matched analyses (1.6% vs. 2%; P = .56).
A secondary analysis of 30-day adverse events by the involved cerebrovascular territory (n = 7,693; 75.1%) revealed similar rates for proximal and distal filter embolic protection devices before propensity matching (2.5% vs. 4.2%; P = .07) and after propensity matching (2.7% vs. 4%; P = .22).
“Given the observed low event rates in the current analysis, an adequately powered randomized trial examining this issue is unlikely to be feasible,” the researchers concluded. – by Jennifer Byrne
Disclosure: Giri reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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