German Study Demonstrates Benefit of Embolic Protection for Carotid Stenting

June 20, 2017—An analysis of a German database evaluating carotid artery stenting procedures concluded that the use of an embolic protection device was independently associated with lower in-hospital risk for stroke or death, major stroke or death, and stroke. The study was published by Christoph Knappich, MD, et al online ahead of print in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions.

In Germany, all open surgical and endovascular procedures on the extracranial carotid artery must be documented in a statutory nationwide quality assurance database. Using this database, the study evaluated an association between intraprocedural and periprocedural variables and in-hospital stroke or death rate after carotid artery stenting.

As summarized in JACC: Cardiovascular Interventions, the analysis involved a total of 13,086 carotid artery stenting procedures for asymptomatic (63.9%) or symptomatic carotid stenosis (mean age, 69.7 years; 69.7% men) that were recorded between 2009 and 2014.

The investigators analyzed the following variables: stent design, stent material, neurophysiological monitoring, periprocedural antiplatelet medication, and use of an embolic protection device. The primary outcome was in-hospital stroke or death; major stroke or death, any stroke, and death, all until discharge, were secondary outcomes. Adjusted relative risks (RRs) were assessed using multilevel multivariable regression analyses.

The primary outcome occurred in 2.4% of the population (asymptomatic, 1.7%; symptomatic patients, 3.7%). Multivariable analysis showed an independent association between the use of an embolic protection device and lower in-hospital rates of stroke or death (adjusted RR, 0.65; 95% confidence interval [CI], 0.5–0.85), major stroke or death (adjusted RR, 0.6; 95% CI, 0.43–0.84), and stroke (adjusted RR, 0.57; 95% CI, 0.43–0.77). Regarding the occurrence of in-hospital death, there was no significant association (adjusted RR, 0.78; 95% CI, 0.46–1.35). None of the outcomes were associated with stent design, stent material, neurophysiological monitoring, or antiplatelet medication, reported the investigators in JACC: Cardiovascular Interventions.