title: Heparin versus bivalirudin for carotid artery stenting using proximal endovascular clamping for neuroprotection: results from a prospective randomized study.
abstract: BACKGROUND
  General recommendations indicate that, during a carotid artery stenting (CAS), sufficient unfractionated heparin (UFH) has to be given to maintain the activated clotting time between 250 to 300 seconds. Bivalirudin use is able to reduce postprocedural bleedings in percutaneous interventions when compared with UFH. The study purpose was to evaluate, in a randomized study, the safety and efficacy of bivalirudin versus heparin during CAS, using proximal endovascular occlusion (PEO) as a distal protection device.
  
  
  METHODS
  From January 2006 to December 2009, 220 patients undergoing CAS using PEO have been randomly assigned to one of the study arms (control arm: 100 UI/kg UFH or bivalirudin arm: 0.75 mg/kg intravenous bolus and intraprocedural infusion at 1.75 mg/kg/h).
  
  
  RESULTS
  Procedural success was achieved in all the patients. No episodes of intraprocedural thrombosis occurred. One major stroke occurred in the bivalirudin arm, and two minor strokes occurred, one in each group. A significant difference in the incidence of postprocedural bleedings was observed between the study groups; bivalirudin use was associated with reduced number of bleedings according to Thrombolysis In Myocardial Infarction criteria.
  
  
  CONCLUSIONS
  The use of bivalirudin should be considered a safe and effective anticoagulation regimen during CAS, using PEO as a distal protection device. Bivalirudin use is associated with a reduced incidence of bleedings.
authors: Invasive Cardiology Laboratory, Cardiology Division, Clinica Montevergine, Mercogliano, Italy. geko50@hotmail.com
authors: Eugenio
authors: E
authors: Stabile
authors: Giovanni
authors: G
authors: Sorropago
authors: Tullio
authors: T
authors: Tesorio
authors: Grigore
authors: G
authors: Popusoi
authors: Vittorio
authors: V
authors: Ambrosini
authors: Maria Teresa
authors: MT
authors: Mottola
authors: Giancarlo
authors: G
authors: Biamino
authors: Paolo
authors: P
authors: Rubino
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D021721:Balloon Occlusion; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006629:Hirudins; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D015607:Stents; D020521:Stroke / Q000517:prevention & control*; D013927:Thrombosis / Q000517:prevention & control; D014914:Whole Blood Coagulation Time
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin