- 作者：Jay Giri ; Kevin F. Kennedy ; Ido Weinberg ; Beau M. Hawkins ; Marcella Calfon Press ; Douglas Drachman ; Daniel J. McCormick ; Herbert D. Aronow ; Christopher J. White ; Kenneth Rosenfield ; Robert W. Yeh
- 关键词：carotid artery stenosis ; carotid artery stenting ; embolic protection devices
- 刊名：JACC: Cardiovascular Interventions
- 出版年：February, 2014
- 年：2014
- 卷：7
- 期：2
- 页码：171-177
- 全文大小：332 K
Objectives
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.聽Food and Drug Administration-approved EPD. The Acculink/Accunet (n聽= 2,617, 21.6%), Xact/Emboshield (n聽= 3,507, 28.9%), and Precise/Angioguard (n聽= 2,696, 22.2%) stent/EPD combinations were used in 72.7% of all cases. The Prot茅g茅/SpiderFx (ev3 Endovascular Inc., Plymouth, Minnesota) (n聽= 453, 3.7%) and Wallstent/Filterwire (Boston Scientific, Natick, Massachusetts) (n聽= 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聽= 0.058) and Xact/Emboshield (2.5% vs. 1.9%; p聽= 0.14) systems that were not statistically different. In adjusted analyses, differences between Precise/Angioguard and Accunet/Acculink (odds聽ratio [OR]: 1.48, 95% confidence interval [CI]: 0.89 to 2.47; p聽= 0.065), Precise/Angioguard and Xact/Emboshield (OR: 1.16, 95% CI: 0.77 to 1.76; p聽= 0.38), and Xact/Emboshield and Accunet/Acculink (OR: 1.28, 95% CI:聽0.82 to 1.97; p聽= 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.