Embolic protection devices for carotid artery stenting: is there a difference between filter and distal occlusive devices?
OBJECTIVE
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.
Zahn
Ralf
R
Herzzentrum, Kardiologie, Ludwigshafen, Germany. erzahn@aol.com
Ischinger
Thomas
T
Mark
Bernd
B
Gass
Sabine
S
Zeymer
Uwe
U
Schmalz
Wolfgang
W
Haerten
Klaus
K
Hauptmann
Karl Eugen
KE
von Leitner
Enz-Rüdiger
ER
Kasper
Wolfgang
W
Tebbe
Ulrich
U
Senges
Jochen
J
D002545:Brain Ischemia / Q000517:prevention & control*; D002339:Carotid Arteries; D016893:Carotid Stenosis / Q000628:therapy*; D002404:Catheterization; D005374:Filtration; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D018579:Patient Selection; D019736:Prostheses and Implants; D012042:Registries; D015607:Stents; D016896:Treatment Outcome