Periprocedural Outcomes of Embolic Protection Device Use in Carotid Artery Stenting.

IF 3.6 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Surgery Pub Date : 2025-10-10 DOI:10.1016/j.jvs.2025.10.004

Santiago Callegari, Gaëlle Romain, Odaly S Balasquide Odeh, Christiany Tapia, Daniel Pinto, Mufti Mushfiqur Rahman, Aseem Vashist, Kim G Smolderen, Carlos Mena-Hurtado

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引用次数: 0

Abstract

Background: Carotid artery stenting (CAS) is frequently used in the management of carotid artery stenosis. Although use of embolic protection devices (EPD) is common, the association with lower mortality has been questioned. We aimed to assess the association between CAS with and without EPD and periprocedural stroke and mortality.

Method: We included patients from the nationwide Vascular Quality Initiative registry who underwent CAS between 2015-2019. Patients undergoing transcarotid artery revascularization were excluded. Outcomes following CAS with either no EPD attempted or failed vs. successful employment of any EPD (distal or proximal) were analyzed in propensity score 1:1 matching cohort. Logistic regression was used to assess in-hospital mortality and stroke and transient ischemia attack (TIA) outcomes (Odds Ratio [OR] with 95% Confidence Interval [CI]). Kaplan-Meier and Cox-proportional hazards regression were used to derive 30-day mortality cumulative incidence and risk. Analyses were replicated using inverse-propensity weighting as a sensitivity analysis.

Results: A total of 19,451 patients were included, with 2,062 per EPD group after 1:1 PSM (aged 67.1±11.7 years, 41.4% female, 87.1% White). CAS without EPD was significantly associated with higher odds of in-hospital mortality (OR 2.40, 95%CI 1.50-3.85, p <0.001), but not stroke/TIA (OR 1.26, 95%CI 0.91-1.75, p = 0.160). The 30-day cumulative incidence and risk of death were twice as high in patients without vs. with EPD (4.3%, 95% CI 3.5%-5.3% vs. 2.0%, 95% CI 1.4%-2.7%; p<0.001; and HR: 2.21 95%CI 1.51-3.24; p<0.001). Sensitivity analysis revealed similar results.

Conclusion: No EPD use was associated with higher in-hospital and 30-day mortality outcome in CAS when compared to EPD used. As the use of CAS increases, our real-world evidence highlights the risks of no EPD use and the potential for including this metric as part of national quality-improvement efforts for adequate CAS practices.

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颈动脉支架植入术中使用栓塞保护装置的围手术期效果。

背景：颈动脉支架植入术是治疗颈动脉狭窄的常用方法。虽然栓塞保护装置（EPD）的使用很常见，但与较低死亡率的关系一直受到质疑。我们的目的是评估伴有或不伴有EPD的CAS与围手术期卒中和死亡率之间的关系。方法：我们纳入了2015-2019年期间在全国血管质量倡议登记处接受CAS的患者。排除经颈动脉重建术的患者。在倾向评分1:1匹配队列中分析CAS后的结果，无论是没有尝试或失败的EPD，还是成功使用任何EPD（远端或近端）。采用Logistic回归评估住院死亡率、卒中和短暂性缺血发作（TIA）结局（优势比[OR]和95%可信区间[CI]）。Kaplan-Meier和cox -比例风险回归用于得出30天死亡率累积发病率和风险。使用反倾向加权作为敏感性分析来重复分析。结果：共纳入19451例患者，1∶1 PSM后EPD组2062例（年龄67.1±11.7岁，女性41.4%，白人87.1%）。未使用EPD的CAS患者与更高的院内死亡率显著相关（OR 2.40, 95%CI 1.50-3.85, p）。结论：与使用EPD的患者相比，未使用EPD的CAS患者与更高的院内死亡率和30天死亡率相关。随着CAS使用的增加，我们的真实世界证据强调了不使用EPD的风险，以及将这一指标作为国家质量改进努力的一部分的潜力，以充分的CAS实践。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Vascular Surgery 医学-外科

CiteScore

7.70

自引率

18.60%

发文量

1469

审稿时长

54 days

期刊介绍： Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.