title: Comparison between proximal versus distal protection devices in 287 cases of carotid revascularization using angioplasty and stenting: periprocedure complications, morbidity, and mortality.
abstract: BACKGROUND
  Embolic protection devices may decrease periprocedural thromboembolic complications during carotid angioplasty and stenting (CAS). When using proximal-protection devices (PPDs), protection starts before crossing the lesion. However, in the medical literature, its use is scarcely reported compared with that of distal-protection filters (DPDs). The objective of this study was to compare periprocedure complications, morbidity, and mortality among 287 consecutive cases of CAS performed with PPDs or DPDs.
  
  
  METHODS
  This was a retrospective analysis of 287 patients treated with CAS at our hospital between January 2006 and March 2012. Periprocedure complications, morbidity, and mortality at 30 days, including ischemic stroke or transient ischemic attack, reperfusion syndrome, myocardial infarction (MI), and death, were globally registered, and the results in PPD and DPD groups were compared.
  
  
  RESULTS
  Two hundred eight patients were treated with DPD and 79 with PPD; 80.8 % were symptomatic. CAS procedures performed with PPD presented a statistically significant greater grade of stenosis than those with DPD (82.5 vs. 74.5 %, p < 0.001). Death rates were 1.9 and 1.3 %; stroke rates were 4.3 and 3.8 %; MI rates were 1.4 and 1.3 %; and total morbidity and mortality rates were 6.2 and 5 % (DPD and PPD groups, respectively); all differences were nonstatistically significant. No statistical difference was found between symptomatic and asymptomatic patients.
  
  
  CONCLUSIONS
  Carotid angioplasty and stenting is a safe procedure to treat carotid disease in our patients. PPDs are not always associated with a greater risk of periprocedure complications, morbidity, and mortality than DPDs despite the greater grade of carotid stenosis in the PPD group. This observation may be of interest in the design of future studies with CAS.
authors.affiliation: Department of Interventional Neuroradiology, Hospital Universitario Virgen de la Arrixaca, Carretera Murcia-Cartagena, S/N, El Palmar, 30100, Murcia, Spain, pacohdezfdez@hotmail.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Hernández-Fernández
authors.forename: G
authors.initials: G
authors.lastname: Parrilla
authors.forename: B
authors.initials: B
authors.lastname: García-Villalba
authors.forename: M
authors.initials: M
authors.lastname: Espinosa de Rueda
authors.forename: M Espinosa
authors.initials: ME
authors.lastname: de Rueda
authors.forename: J
authors.initials: J
authors.lastname: Zamarro
authors.forename: M
authors.initials: M
authors.lastname: Garrote
authors.forename: A
authors.initials: A
authors.lastname: Moreno
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods*; D002545:Brain Ischemia / Q000401:mortality / Q000517:prevention & control; D016893:Carotid Stenosis / Q000401:mortality* / Q000628:therapy*; D057505:Embolic Protection Devices; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control*; D015427:Reperfusion Injury / Q000401:mortality / Q000517:prevention & control; D012189:Retrospective Studies; D015607:Stents