NCDR Analysis Compares Effectiveness of Commonly Used CAS Devices

January 15, 2014—Jay Giri, MD, et al published findings from a National Cardiovascular Data Registry (NCDR) analysis that evaluated the comparative effectiveness of commonly used devices for carotid artery stenting (CAS). The study, which sought to characterize the usage and outcomes of CAS platforms, is available online ahead of print in the Journal of the American College of Cardiology: Cardiovascular Interventions.

The background of the study is that a variety of stents and embolic protection devices (EPDs) are used for CAS but that little is known about current usage patterns and differences in outcomes with these devices.

As summarized in Journal of the American College of Cardiology: Cardiovascular Interventions, the investigators analyzed 12,135 consecutive CAS procedures in the NCDR Carotid Artery Revascularization and Endarterectomy registry performed between January 1, 2007, and March 31, 2012. Baseline characteristics and crude and multivariable-adjusted rates of in-hospital combined death/stroke were compared among patients treated with Acculink/Accunet (Abbott Vascular, Santa Clara, CA), Xact/Emboshield (Abbott Vascular), and Precise/Angioguard (Cordis Corporation, Bridgewater, NJ) stent/EPD combinations.

The investigators reported that in 78.2% of cases, stents were used in conjunction with their specific, corresponding US 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 (Covidien, Mansfield, MA) (n = 453; 3.7%) and Wallstent/Filterwire (Boston Scientific Corporation, Natick, MA) (n = 213; 1.8%) devices were used in a minority of cases. 

The investigators found that 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 = .058) and Xact/Emboshield (2.5% vs 1.9%; P = .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], 0.89–2.47; P = .065), Precise/Angioguard and Xact/Emboshield (OR, 1.16; 95% CI, 0.77–1.76; P = .38), and Xact/Emboshield and Accunet/Acculink (OR, 1.28; 95% CI, 0.82–1.97; P = .18) remained nonsignificant.

In modern practice in the United States, 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, concluded the investigators in Journal of the American College of Cardiology: Cardiovascular Interventions.