CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY
Embolic Protection Devices for Carotid Artery Stenting
Is There a Difference Between Filter and Distal Occlusive Devices?
Ralf Zahn, MD, FESC*,*,
Thomas Ischinger, MD, FESC ,
Bernd Mark, MD*,
Sabine Gass, MD ,
Uwe Zeymer, MD, FESC*,
Wolfgang Schmalz, MD ,
Klaus Haerten, MD||,
Karl Eugen Hauptmann, MD¶,
Enz-Rüdiger von Leitner, MD#,
Wolfgang Kasper, MD**,
Ulrich Tebbe, MD, FESC ,
Jochen Senges, MD, FACC, FESC* for the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)
* Herzzentrum, Kardiologie, Ludwigshafen
Städtisches Klinikum, Kardiologie, München-Bogenhausen
Städtisches Klinikum, Neurologie, Ludwigshafen
Stadtkrankenhaus, Kardiologie, Worms
|| Marienkrankenhaus, Kardiologie, Wesel
¶ Krankenhaus der Barmherzigen Brüder, Kardiologie, Trier
# Klinikum Siloah, Kardiologie, Hannover
** St. Josefs Hospital, Kardiologie, Wiesbaden
 Klinikum Lippe-Detmold, Kardiologie, Detmold, Germany
Manuscript received December 16, 2004;
revised manuscript received February 12, 2005,
accepted February 22, 2005.
* Reprint requests and correspondence: Dr. Ralf Zahn, Herzzentrum Ludwigshafen, Dept. of Cardiology, Bremserstrasse 79, D-67063 Ludwigshafen, Germany. (Email: erzahn{at}aol.com).
OBJECTIVES: We sought to compare the efficacy of a filter embolic protection device (F-EPD) and a distal occlusive embolic protection device (DO-EPD) in patients undergoing carotid artery stenting (CAS).
BACKGROUND: The embolic protection device (EPD) may lower the periprocedural rate of cerebral ischemic events during CAS. However, it is unclear whether there is a difference in effectiveness between the different types of EPD.
METHODS: We analyzed data from the Carotid Artery Stent (CAS) Registry.
RESULTS: From July 1996 to July 2003, 1,734 patients were included in the prospective CAS Registry. Of these patients, 729 patients were treated with an EPD, 553 (75.9%) with F-EPD, and 176 (24.1%) with DO-EPD. Patients treated with DO-EPD were more likely to be treated for symptomatic stenosis (64.5% vs. 53.4%, p = 0.011). The carotid lesions in patients treated under DO-EPD seemed to be more complicated, as expressed by a higher proportion of ulcers (p = 0.035), severe calcification (p = 0.039), a longer lesion length (p = 0.025), and a higher pre-interventional grade of stenosis (p < 0.001). The median duration of the CAS intervention was 30 min in the DO-EPD group, compared with 48 min in the filter group (p < 0.001). No differences in clinical events rate between the two groups of protection devices were observed. Multivariate analysis on the occurrence of the combined end point of in-hospital death or stroke found no difference between filter- and DO-EPD (4 of 176 [2.3%] for DO-EPD vs. 10 of 551 [1.8%] for F-EPD; adjusted odds ratio = 1.04, 95% confidence interval 0.24 to 4.44; p = 0.958).
CONCLUSIONS: Filter EPD is the currently preferred method of EPD in clinical practice. Both F-EPD and DO-EPD seem to be equally effective during CAS.
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Abbreviations and Acronyms
| | ALKK = Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte | | CAS = carotid artery stenting | | CEA = carotid endarterectomy | | CI = confidence interval | | DO-EPD = distal occlusive embolic protection device | | EPD = embolic protection device | | F-EPD = filter embolic protection device | | OR = odds ratio |
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