Comparative effectiveness of commonly used devices for carotid artery stenting: an NCDR Analysis (National Cardiovascular Data Registry).
OBJECTIVE
This study sought to characterize usage and outcomes of carotid stenting platforms.


BACKGROUND
A variety of stents and embolic protection devices (EPDs) are used for carotid artery stenting. Little is known about current usage patterns and differences in outcomes with these devices.


METHODS
We analyzed 12,135 consecutive carotid stent procedures in the NCDR (National Cardiovascular Data Registry) CARE (Carotid Artery Revascularization and Endarterectomy) registry performed between January 1, 2007 and March 31, 2012. We compared baseline characteristics and crude and multivariable-adjusted rates of in-hospital combined death/stroke among patients treated with Acculink/Accunet (Abbott Laboratories, Abbott Park, Illinois), Xact/Emboshield (Abbott), and Precise/Angioguard (Cordis Corporation, Bridgewater, New Jersey) stent/EPD combinations.


RESULTS
In 78.2% of cases, stents were used in conjunction with their specific, corresponding U.S. Food and Drug Administration-approved EPD. The Acculink/Accunet (n = 2,617, 21.6%), Xact/Emboshield (n = 3,507, 28.9%), and Precise/Angioguard (n = 2,696, 22.2%) stent/EPD combinations were used in 72.7% of all cases. The Protégé/SpiderFx (ev3 Endovascular Inc., Plymouth, Minnesota) (n = 453, 3.7%) and Wallstent/Filterwire (Boston Scientific, Natick, Massachusetts) (n = 213, 1.8%) devices were used in a minority of cases. In unadjusted analyses, the Precise/Angioguard system was associated with higher rates of the primary outcome than were the Acculink/Accunet (2.5% vs. 1.8%; p = 0.058) and Xact/Emboshield (2.5% vs. 1.9%; p = 0.14) systems that were not statistically different. In adjusted analyses, differences between Precise/Angioguard and Accunet/Acculink (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 0.89 to 2.47; p = 0.065), Precise/Angioguard and Xact/Emboshield (OR: 1.16, 95% CI: 0.77 to 1.76; p = 0.38), and Xact/Emboshield and Accunet/Acculink (OR: 1.28, 95% CI: 0.82 to 1.97; p = 0.18) remained nonsignificant.


CONCLUSIONS
In modern U.S. practice, the Acculink/Accunet, Xact/Emboshield, and Precise/Angioguard carotid stenting systems are used in most cases and are associated with similarly low rates of adverse events.
Cardiovascular Medicine Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. Electronic address: jay.giri@uphs.upenn.edu.
Jay
J
Giri
St. Luke's Mid-America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri.
Kevin F
KF
Kennedy
Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Ido
I
Weinberg
Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Beau M
BM
Hawkins
Ronald Reagan UCLA Medical Center, University of California-Los Angeles, Los Angeles, California.
Marcella Calfon
MC
Press
Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Douglas
D
Drachman
Cardiovascular Medicine Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Daniel J
DJ
McCormick
St. Joseph Mercy Hospital, Ann Arbor, Michigan.
Herbert D
HD
Aronow
John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana.
Christopher J
CJ
White
Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Kenneth
K
Rosenfield
Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Robert W
RW
Yeh
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016009:Chi-Square Distribution; D057186:Comparative Effectiveness Research; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
carotid artery stenosis; carotid artery stenting; embolic protection devices