The Use of Embolic Protection Devices Is Associated With a Lower Stroke and Death Rate After Carotid Stenting

JACC Cardiovasc Interv. 2017 Jun 26;10(12):1257-1265. doi: 10.1016/j.jcin.2017.03.032.


Objectives: The aim of this study was to analyze the association between intraprocedural and periprocedural variables and in-hospital stroke or death rate after carotid artery stenting.

Background: In Germany, all open surgical and endovascular procedures on the extracranial carotid artery must be documented in a statutory nationwide quality assurance database.

Methods: 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) between 2009 and 2014 were recorded. The following variables were analyzed: 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.

Results: The primary outcome occurred in 2.4% of the population (1.7% in asymptomatic and 3.7% in symptomatic patients). The 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]: 0.50 to 0.85), major stroke or death (adjusted RR: 0.60; 95% CI: 0.43 to 0.84), and stroke (adjusted RR: 0.57; 95% CI: 0.43 to 0.77). Regarding the occurrence of in-hospital death, there was no significant association (adjusted RR: 0.78; 95% CI: 0.46 to 1.35). None of the outcomes was associated with stent design, stent material, neurophysiological monitoring, or antiplatelet medication.

Conclusions: 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.

Keywords: carotid artery disease; carotid artery stenting; death; embolic protection device; stroke.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angioplasty / adverse effects
  • Angioplasty / instrumentation*
  • Angioplasty / mortality
  • Asymptomatic Diseases
  • Carotid Stenosis / complications
  • Carotid Stenosis / diagnosis
  • Carotid Stenosis / mortality
  • Carotid Stenosis / therapy*
  • Chi-Square Distribution
  • Databases, Factual
  • Embolic Protection Devices*
  • Female
  • Germany
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Prosthesis Design
  • Protective Factors
  • Registries
  • Retrospective Studies
  • Risk Factors
  • Stents*
  • Stroke / diagnosis
  • Stroke / etiology
  • Stroke / mortality
  • Stroke / prevention & control*
  • Time Factors
  • Treatment Outcome