Heparin versus bivalirudin for carotid artery stenting using proximal endovascular clamping for neuroprotection: results from a prospective randomized study.
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.
Stabile
Eugenio
E
Invasive Cardiology Laboratory, Cardiology Division, Clinica Montevergine, Mercogliano, Italy. geko50@hotmail.com
Sorropago
Giovanni
G
Tesorio
Tullio
T
Popusoi
Grigore
G
Ambrosini
Vittorio
V
Mottola
Maria Teresa
MT
Biamino
Giancarlo
G
Rubino
Paolo
P
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
D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin