The CAPTURE registry: results of carotid stenting with embolic protection in the post approval setting.
BACKGROUND
Pivotal study data examining carotid stenting with embolic protection as a less invasive alternative to endarterectomy for high surgical risk patients have been acquired under controlled conditions with highly selected physicians and hospitals. This report examines outcomes of carotid stenting post-approval after diffusion of this technology to a broader cross-section of physicians and hospitals.


METHODS
The Carotid Acculink/Accunet Post-Approval Trial to Uncover Unanticipated or Rare Events (CAPTURE) is a prospective, multi-center registry to assess two important aspects of the post-IDE experience: the safety of carotid stenting by physicians with varying levels of experience as a measure of the adequacy of physician training, and the identification of rare/unexpected device-related complications. The primary endpoint was a composite of death, any stroke, or myocardial infarction within 30 days post-procedure.


RESULTS
3,500 patients were enrolled by 353 physicians at 144 sites. The 30-day primary endpoint event rate was 6.3% (95% CI: 5.5-7.1%) and did not differ among the three operator experience levels (5.3%, 6.0%, and 7.4%; P = 0.31) from most to least experienced, respectively. There were no differences in outcomes among physician specialties when adjusted for case mix. There were no unanticipated device related adverse events.


CONCLUSIONS
The results of the CAPTURE study compare favorably to those achieved in the predicate pivotal investigations, and suggest that the post-approval transfer of this new therapy to the community practice setting via carotid stent training programs is effective in preparing physicians with varying experience levels and specialty training backgrounds.
Gray
William A
WA
Center for Interventional Vascular Therapies, Columbia University, 161 Fort Washington Avenue 5th Floor, New York, NY 10032, USA. wgray@crf.org
Yadav
Jay S
JS
Verta
Patrick
P
Scicli
Andrea
A
Fairman
Ronald
R
Wholey
Mark
M
Hopkins
L Nelson
LN
Atkinson
Richard
R
Raabe
Rod
R
Barnwell
Stanley
S
Green
Richard
R
D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation / Q000193:education; D017536:Carotid Artery, Common / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery*; D002983:Clinical Competence; D004617:Embolism / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011358:Product Surveillance, Postmarketing; D011446:Prospective Studies; D012042:Registries; D012107:Research Design; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology