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Comparison Between Proximal Versus Distal Protection Devices in 287 Cases of Carotid Revascularization Using Angioplasty and Stenting: Periprocedure Complications, Morbidity, and Mortality.
MedLine Citation:
PMID:  23912495     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Embolic protection devices may decrease periprocedural thromboembolic complications during carotid angioplasty and stenting (CAS). When using proximal-protection devices (PPDs), protection starts before crossing the lesion. However, in the medical literature, its use is scarcely reported compared with that of distal-protection filters (DPDs). The objective of this study was to compare periprocedure complications, morbidity, and mortality among 287 consecutive cases of CAS performed with PPDs or DPDs.
PATIENTS AND METHODS: This was a retrospective analysis of 287 patients treated with CAS at our hospital between January 2006 and March 2012. Periprocedure complications, morbidity, and mortality at 30 days, including ischemic stroke or transient ischemic attack, reperfusion syndrome, myocardial infarction (MI), and death, were globally registered, and the results in PPD and DPD groups were compared.
RESULTS: Two hundred eight patients were treated with DPD and 79 with PPD; 80.8 % were symptomatic. CAS procedures performed with PPD presented a statistically significant greater grade of stenosis than those with DPD (82.5 vs. 74.5 %, p < 0.001). Death rates were 1.9 and 1.3 %; stroke rates were 4.3 and 3.8 %; MI rates were 1.4 and 1.3 %; and total morbidity and mortality rates were 6.2 and 5 % (DPD and PPD groups, respectively); all differences were nonstatistically significant. No statistical difference was found between symptomatic and asymptomatic patients.
CONCLUSION: Carotid angioplasty and stenting is a safe procedure to treat carotid disease in our patients. PPDs are not always associated with a greater risk of periprocedure complications, morbidity, and mortality than DPDs despite the greater grade of carotid stenosis in the PPD group. This observation may be of interest in the design of future studies with CAS.
Authors:
Francisco Hernández-Fernández; G Parrilla; B García-Villalba; M Espinosa de Rueda; J Zamarro; M Garrote; A Moreno
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-8-3
Journal Detail:
Title:  Cardiovascular and interventional radiology     Volume:  -     ISSN:  1432-086X     ISO Abbreviation:  Cardiovasc Intervent Radiol     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-8-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8003538     Medline TA:  Cardiovasc Intervent Radiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Interventional Neuroradiology, Hospital Universitario Virgen de la Arrixaca, Carretera Murcia-Cartagena, S/N, El Palmar, 30100, Murcia, Spain, pacohdezfdez@hotmail.com.
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