Author + information
- Received November 29, 2016
- Revision received February 23, 2017
- Accepted March 23, 2017
- Published online June 19, 2017.
- Christoph Knappich, MDa,
- Andreas Kuehnl, MD, MPH, MBAa,
- Pavlos Tsantilas, MDa,
- Sofie Schmid, MDa,
- Thorben Breitkreuzb,
- Michael Kallmayer, MDa,
- Alexander Zimmermann, MD, MHBAa and
- Hans-Henning Eckstein, MD, PhDa,∗ ()
- aDepartment of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- bAQUA-Institut für Angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany
- ↵∗Address for correspondence:
Univ.-Prof. Dr. Hans-Henning Eckstein, Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany.
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.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 29, 2016.
- Revision received February 23, 2017.
- Accepted March 23, 2017.
- 2017 American College of Cardiology Foundation