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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.

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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