Comparison of the safety and efficacy of emboli prevention devices versus platelet glycoprotein IIb/IIIa inhibition during carotid stenting.
Distal embolization is the main potential risk of carotid stenting, and techniques to minimize this risk are evolving. Between July 1998 and March 2002, 305 consecutive patients who underwent elective or urgent percutaneous carotid intervention at The Cleveland Clinic were prospectively followed. During this period, the clinical practice of carotid stenting evolved from the routine use of glycoprotein IIb/IIIa inhibitors (GPIs) to routine emboli-prevention device (EPD) placement. A total of 199 patients received adjunctive GPIs (91% abciximab), and 106 patients underwent the procedure with an EPD (85% filter design, 15% occlusive balloon). At 30 days, the composite end point of neurologic death, nonfatal stroke, and major bleeding, including intracranial hemorrhage, was significantly lower among patients treated with EPDs compared with those treated with GPIs (0% vs 5.1%, p = 0.02). EPDs may provide an overall safer and more effective means of neuroprotection during carotid stenting than GPIs.
Chan
Albert W
AW
Division of Cardiology, Royal Columbian Hospital, New Westminster, British Columbia, Canada.
Yadav
Jay S
JS
Bhatt
Deepak L
DL
Bajzer
Christopher T
CT
Gum
Patricia A
PA
Roffi
Marco
M
Cho
Leslie
L
Agah
Ramtin
R
Topol
Eric J
EJ
D000077284:Abciximab; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D021721:Balloon Occlusion / Q000295:instrumentation*; D016893:Carotid Stenosis / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000401:mortality / Q000517:prevention & control; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage* / Q000009:adverse effects; D020766:Intracranial Embolism / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000187:drug effects; D010043:Outcome and Process Assessment, Health Care; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D019736:Prostheses and Implants; D015607:Stents
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab