Study Shows CAS Using Mo.Ma Cerebral Protection Device in Octogenarians to Be Safe

July 1, 2010—In Catheterization and Cardiovascular Interventions, Antonio Micari, MD, et al have published findings from a multicenter prospective registry that sought to show that carotid artery stenting (CAS) in octogenarians is safe and effective if performed in high-volume centers by experienced operators (2010;76:9–15). The investigators noted that the background of the study is that CAS has been proposed as an alternative to carotid endarterectomy in elderly patients with discrepant results; however, the use of proximal neuroprotection devices has not been evaluated in octogenarians.

As detailed in the article, 198 octogenarians (135 men; mean age, 83.2 years) were treated at three institutions from July 2005 to May 2009 in this registry. All patients underwent CAS using a proximal endovascular occlusion device (Mo.Ma., Medtronic Invatec, Frauenfeld, Switzerland). An independent neurologist evaluated all patients, and the primary endpoint was the death and stroke rate at 30 days.

The investigators reported that 39.4% of the patients were symptomatic. Procedural success was 100%. The in-hospital complications were two minor and two major strokes (2.02%). No device-related complications and no serious access-site complications were noted. Between discharge and 30-day follow-up, one patient died due to a cardiac arrest. The overall 30-day combined stroke/death rate was 2.52%, resulting in 1.61% event incidence in asymptomatic patients and a 3.9% incidence in symptomatic patients (P = ns). Logistic regression did not identify independent predictors of neurological events, except for female gender.

The investigators concluded that this multicenter prospective registry shows that CAS performed with proximal flow blockage is safe and feasible in octogenarians, with 30-day death and stroke rates that are similar to those of the overall population and within the international guidelines.