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European Heart Journal 2004 25(17):1550-1558; doi:10.1016/j.ehj.2004.06.018
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Embolic protection devices for carotid artery stenting: better results than stenting without protection?

Ralf Zahna,*, Bernd Marka, Nikolaj Niedermaierb, Uwe Zeymera, Peter Limbourgc, Thomas Ischingerd, Klaus Haertene, Karl Eugen Hauptmannf, Enz-Rüdiger von Leitnerg, Wolfgang Kasperh, Ulrich Tebbei and Jochen Sengesa for the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)

a Herzzentrum, Kardiologie, Ludwigshafen, Germany
b Städtisches Klinikum, Neurologie, Ludwigshafen, Germany
c Stadtkrankenhaus, Kardiologie, Worms, Germany
d Städtisches Klinikum, Kardiologie, München-Bogenhausen, Germany
e Marienkrankenhaus, Kardiologie, Wesel, Germany
f Krankenhaus der Barmherzigen Brüder, Kardiologie, Trier, Germany
g Klinikum Siloah, Kardiologie, Hannover, Germany
h St. Josefs Hospital, Kardiologie, Wiesbaden, Germany
i Klinikum Lippe-Detmold, Kardiologie, Detmold, Germany

Received March 6, 2004; revised June 1, 2004; accepted June 10, 2004 * Corresponding author. Tel.: +49-621-503-4000; fax: +49-621-503-4002 (E-mail: erzahn{at}aol.com).

AIMS: Carotid artery stenting (CAS) for carotid artery stenoses has become an alternative to carotid endarterectomy. However, CAS itself can cause cerebral ischaemic events. Embolic protection devices (PD) promise to reduce the incidence of these events.

METHODS AND RESULTS: From July 1996 to March 2003, 1483 patients from 26 hospitals were included in the prospective CAS Registry of the ALKK study group. A PD was used in 668 of 1483 patients (45%). The use of a PD has grown rapidly over the years and reached 100% in 2003. Patients treated with a PD had prior carotid artery dilatation more often (3.5% versus 1%, p<0.001), a prior myocardial infarction (34% versus 27.4%, p=0.007) and a history of arterial hypertension (89.9% versus 78.6%, p=0.007) compared to patients treated without a PD. A thrombus was more often visible in patients treated under distal protection (16.5% versus 8%, p<0.001). The use of a PD led to a 10-min longer intervention (45 min versus 35 min median, p<0.001). Patients treated with a PD had a lower rate of ipsilateral stroke (1.7% versus 4.1%, p=0.007) and a lower rate of all non-fatal strokes and all deaths (2.1% versus 4.9%, p=0.004) during the hospital stay. This was confirmed by multiple logistic regression analysis (adjusted OR=0.45, 95% CI: 0.23–0.91, p=0.026). A similar reduction could be found for symptomatic as well as asymptomatic carotid artery stenoses.

CONCLUSION: Since 1996 there has been a steady increase in the use of PDs for CAS, with a 100% use in 2003. The use of a PD may lower the rate of ipsilateral strokes during CAS.


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