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Influence of stent design and use of protection devices on outcome of carotid artery stenting: a pooled analysis of individual patient data.

Publication ,  Journal Article
Wodarg, F; Turner, EL; Dobson, J; Ringleb, PA; Mali, WP; Fraedrich, G; Chatellier, G; Bequemin, J-P; Brown, MM; Algra, A; Mas, J-L; Jansen, O ...
Published in: J Neurointerv Surg
December 2018

BACKGROUND AND PURPOSE: Carotid artery stenting is an alternative to endarterectomy for the treatment of symptomatic carotid stenosis but was associated with a higher risk of procedural stroke or death in randomized controlled trials (RCTs). Technical aspects of treatment may partly explain these results. The purpose of this analysis was to investigate the influence of technical aspects such as stent design or the use of protection devices, as well as clinical variables, on procedural risk. METHODS: We pooled data of 1557 individual patients receiving stent treatment in three large RCTs comparing stenting versus endarterectomy for symptomatic carotid stenosis. The primary outcome event was any procedural stroke or death occurring within 30 days after stenting. RESULTS: Procedural stroke or death occurred significantly more often with the use of open-cell stents (61/595 patients, 10.3%) than with closed-cell stents (58/962 patients, 6.0%; RR 1.76; 95% CI 1.23 to 2.52; P=0.002). Procedural stroke or death occurred in 76/950 patients (8.0%) treated with protection devices (predominantly distal filters) and in 43/607 (7.1%) treated without protection devices (RR 1.10; 95% CI 0.71 to 1.70; P=0.67). Clinical variables predicting the primary outcome event were age, severity of the qualifying event, history of prior stroke, and level of disability at baseline. The effect of stent design remained similar after adjustment for these variables. CONCLUSIONS: In symptomatic carotid stenosis, the use of stents with a closed-cell design is independently associated with a lower risk of procedural stroke or death compared with open-cell stents. Filter-type protection devices do not appear to reduce procedural risk.

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Published In

J Neurointerv Surg

DOI

EISSN

1759-8486

Publication Date

December 2018

Volume

10

Issue

12

Start / End Page

1149 / 1154

Location

England

Related Subject Headings

  • Treatment Outcome
  • Stroke
  • Stents
  • Randomized Controlled Trials as Topic
  • Protective Devices
  • Middle Aged
  • Male
  • Humans
  • Female
  • Equipment Design
 

Citation

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Wodarg, F., Turner, E. L., Dobson, J., Ringleb, P. A., Mali, W. P., Fraedrich, G., … Carotid Stenosis Trialists’ Collaboration, . (2018). Influence of stent design and use of protection devices on outcome of carotid artery stenting: a pooled analysis of individual patient data. J Neurointerv Surg, 10(12), 1149–1154. https://doi.org/10.1136/neurintsurg-2017-013622
Wodarg, Fritz, Elisabeth L. Turner, Joanna Dobson, Peter A. Ringleb, Willem P. Mali, Gustav Fraedrich, Gilles Chatellier, et al. “Influence of stent design and use of protection devices on outcome of carotid artery stenting: a pooled analysis of individual patient data.J Neurointerv Surg 10, no. 12 (December 2018): 1149–54. https://doi.org/10.1136/neurintsurg-2017-013622.
Wodarg F, Turner EL, Dobson J, Ringleb PA, Mali WP, Fraedrich G, et al. Influence of stent design and use of protection devices on outcome of carotid artery stenting: a pooled analysis of individual patient data. J Neurointerv Surg. 2018 Dec;10(12):1149–54.
Wodarg, Fritz, et al. “Influence of stent design and use of protection devices on outcome of carotid artery stenting: a pooled analysis of individual patient data.J Neurointerv Surg, vol. 10, no. 12, Dec. 2018, pp. 1149–54. Pubmed, doi:10.1136/neurintsurg-2017-013622.
Wodarg F, Turner EL, Dobson J, Ringleb PA, Mali WP, Fraedrich G, Chatellier G, Bequemin J-P, Brown MM, Algra A, Mas J-L, Jansen O, Bonati LH, Carotid Stenosis Trialists’ Collaboration. Influence of stent design and use of protection devices on outcome of carotid artery stenting: a pooled analysis of individual patient data. J Neurointerv Surg. 2018 Dec;10(12):1149–1154.

Published In

J Neurointerv Surg

DOI

EISSN

1759-8486

Publication Date

December 2018

Volume

10

Issue

12

Start / End Page

1149 / 1154

Location

England

Related Subject Headings

  • Treatment Outcome
  • Stroke
  • Stents
  • Randomized Controlled Trials as Topic
  • Protective Devices
  • Middle Aged
  • Male
  • Humans
  • Female
  • Equipment Design