Single-Center Study Supports Using Proximal Endovascular Occlusion During CAS

April 13, 2010—In the Journal of the American College of Cardiology, Eugenio Stabile, MD, et al published results from a single-center registry studying the use of proximal endovascular occlusion (PEO) for carotid artery stenting (CAS) procedures in an unselected patient population (2010;55:1661–1667). The background of the study is that in published multicenter registries, the use of PEO for CAS has been demonstrated to be safe and effective in patient populations selected for anatomical and/or clinical conditions.

This study was composed of 1,300 patients who underwent CAS using PEO from July 2004 to May 2009. Patients received an independent neurological assessment before the procedure and at 1 hour, 24 hours, and 30 days after the procedure. Procedural success was achieved in 99.7% of patients. In-hospital, major adverse cardiac, or cerebrovascular events included five deaths (0.38%), six major strokes (0.46%), five minor strokes (0.38%), and no acute myocardial infarction. At 30 days of follow-up, two additional patients died (0.15%), and one patient had a minor stroke (0.07%). The 30-day stroke and death incidence was 1.38% (n = 19). Symptomatic patients presented with a higher 30-day stroke and death incidence when compared with asymptomatic patients (3.04% vs 0.82%; P < .05). No significant difference in 30-day stroke and death rates were observed between patients at high (1.88%; n = 12) and average (1.07; n = 7) surgical risk (P = NS). Operator experience, symptomatic status, and hypertension were found to be independent predictors of adverse events.

The investigators concluded that the use of PEO for CAS is safe and effective in an unselected patient population. Anatomical and/or clinical conditions of high surgical risk were not associated with an increased rate of adverse events.