Volume 92, Issue 4 pp. 743-749
Peripheral Vascular Disease

Comparison of devices used in carotid artery stenting: A vascular quality initiative analysis of commonly used carotid stents and embolic protection devices

Ashwat S. Dhillon MD

Corresponding Author

Ashwat S. Dhillon MD

Division of Cardiovascular Medicine, University of Southern California Keck School of Medicine, Los Angeles, California

Correspondence Ashwat S. Dhillon, MD, 1510 San Pablo St. Suite 322, University of Southern California Keck School of Medicine, Los Angeles, CA 90033. Email: [email protected]Search for more papers by this author
Sisi Li

Sisi Li

Department of Biostatistics, University of Southern California, Los Angeles, California

Search for more papers by this author
Juan Pablo Lewinger PhD

Juan Pablo Lewinger PhD

Department of Biostatistics, University of Southern California, Los Angeles, California

Search for more papers by this author
David M. Shavelle MD

David M. Shavelle MD

Division of Cardiovascular Medicine, University of Southern California Keck School of Medicine, Los Angeles, California

Search for more papers by this author
Ray V. Matthews MD

Ray V. Matthews MD

Division of Cardiovascular Medicine, University of Southern California Keck School of Medicine, Los Angeles, California

Search for more papers by this author
Leonardo C. Clavijo MD, PhD

Leonardo C. Clavijo MD, PhD

Division of Cardiovascular Medicine, University of Southern California Keck School of Medicine, Los Angeles, California

Search for more papers by this author
Fred A. Weaver MD

Fred A. Weaver MD

Division of Vascular Surgery, University of Southern California Keck School of Medicine, Los Angeles, California

Search for more papers by this author
Parveen Garg MD, MPH

Parveen Garg MD, MPH

Division of Cardiovascular Medicine, University of Southern California Keck School of Medicine, Los Angeles, California

Search for more papers by this author
First published: 18 July 2018
Citations: 9

Abstract

Background

Data regarding efficacy of various stent and embolic protection device (EPD) combinations to prevent stroke during carotid artery stenting (CAS) is limited. We compared post-procedure inpatient neurologic outcomes across various carotid stent-EPD platforms recorded in the Vascular Quality Initiative (VQI) registry.

Methods

We analyzed 13,786 consecutive CAS procedures in the VQI registry performed between January 1, 2005 and December 31, 2015. The most commonly used stent-EPD combinations (n = 5407) were included in the analysis. Post-procedure inpatient neurologic outcomes included (1) ipsilateral stroke/transient ischemic attack (TIA) and (2) any stroke/TIA. Multivariate generalized estimating equation regression analysis was performed, adjusting for age, sex, tobacco use, coronary artery disease, congestive heart failure, prior stroke/TIA, hypertension, history of carotid revascularization, and presence of a second ipsilateral stenosis >70%, to determine whether risk of outcomes differed according to device.

Results

Of 13,786 CAS procedures, Xact-Emboshield (n = 2,438, 17.6%), Precise-Angioguard (n = 1,480, 10.7%), Acculink-Accunet (n = 829, 6.01%), and Acculink-Emboshield (n = 660, 4.8%) were the most commonly used combinations, accounting for a total of 5,407 procedures. Inpatient event rates for ipsilateral stroke/TIA and any stroke/TIA were 1.9 and 2.7% in the Accunet-Acculink, 3.0 and 3.2% in Acculink-Emboshield, 3.2 and 4.1% in Precise-Angioguard and 2.2 and 3.0% in Xact-Emboshield. There was no evidence of difference in risk of ipsilateral stroke/TIA or any stroke/TIA across device combinations (P = 0.15 and P = 0.16, respectively).

Conclusion

CAS with current carotid stent-EPD combinations is associated with low rates of inpatient stroke/TIA. There is no statistically significant difference in rates of inpatient stroke/TIA across device combinations.

The full text of this article hosted at iucr.org is unavailable due to technical difficulties.