Safety and Efficacy of A Single Embolic Protection Device-Stent Combo for Carotid Revascularization

Abstract

AIM: Carotid artery stenting (CAS) yields similar safety and efficacy results in comparison to carotid endarterectomy. There is however a plethora of devices for CAS, and selection remains problematic. We hypothesized that operators proficient with a single embolic protection device-stent combination can use it effectively for most CAS cases.

METHODS: We collected data on all patients undergoing CAS at our institutions, distinguishing patients undergoing revascularization with or without the Angioguard-Precise embolic protection-stent combo.The primary outcome was the risk ofmajor adverse events (MAE), i.e. the composite of death, stroke, transient ischemic attack, or myocardial infarction.

RESULTS: A total of 532 patients were treated on 562 lesions. Angioguard-Precise could be used in 447 (84%) patients [471 (84%) lesions], whereas other approaches were used in 85 (16%) patients [91 (16%) lesions]. The groups were similar for most characteristics, but prior carotid revascularization, brachial/radial access, common carotid target lesion, and predilation were less common in the single combo group, whereas stenting and use of embolic protection were less frequent in the other cases (all p < 0.05). Procedural success was achieved in 462 (98%) of cases in the combo group and 89 (98%) in the other group (p=0.695). No significant differences in MAE were found in-hospital [respectively 7 (2%) vs 0, p = 0.604], at 30 days [8 (1.7%) vs 1 (1.2%), p = 1], or at long-term [44 (10%) vs 11 (13%), p = 0.294].

CONCLUSIONS: Operators proficient with a specific embolic protection-stent combination can use it with favorable results in the vast majority of patients.