Embolic protection devices for carotid artery stenting: is there a difference between filter and distal occlusive devices?

OBJECTIVES: We sought to compare the efficacy of a filter embolic protection device (F-EPD) and a distal occlusive embolic protection device (DO-EPD) in patients undergoing carotid artery stenting (CAS). BACKGROUND: The embolic protection device (EPD) may lower the periprocedural rate of cerebral ischemic events during CAS. However, it is unclear whether there is a difference in effectiveness between the different types of EPD. METHODS: We analyzed data from the Carotid Artery Stent (CAS) Registry. RESULTS: From July 1996 to July 2003, 1,734 patients were included in the prospective CAS Registry. Of these patients, 729 patients were treated with an EPD, 553 (75.9%) with F-EPD, and 176 (24.1%) with DO-EPD. Patients treated with DO-EPD were more likely to be treated for symptomatic stenosis (64.5% vs. 53.4%, p = 0.011). The carotid lesions in patients treated under DO-EPD seemed to be more complicated, as expressed by a higher proportion of ulcers (p = 0.035), severe calcification (p = 0.039), a longer lesion length (p = 0.025), and a higher pre-interventional grade of stenosis (p < 0.001). The median duration of the CAS intervention was 30 min in the DO-EPD group, compared with 48 min in the filter group (p < 0.001). No differences in clinical events rate between the two groups of protection devices were observed. Multivariate analysis on the occurrence of the combined end point of in-hospital death or stroke found no difference between filter- and DO-EPD (4 of 176 [2.3%] for DO-EPD vs. 10 of 551 [1.8%] for F-EPD; adjusted odds ratio = 1.04, 95% confidence interval 0.24 to 4.44; p = 0.958). CONCLUSIONS: Filter EPD is the currently preferred method of EPD in clinical practice. Both F-EPD and DO-EPD seem to be equally effective during CAS.

Circulating adhesion molecules in patients with internal carotid artery stenosis.

To study the association of plasma concentrations of soluble adhesion molecules (sICAM-1, sVCAM-1 and sE-selectin) with atheroslerotic lesions at the origin of the internal carotid artery (ICA). 179 subjects were investigated by color Doppler ultrasound of whom 133 had and 46 had no plaques at the ICA origin. Stepwise logistic regression analysis revealed that hypertension (p < 0.001), sICAM-1 concentrations (p < 0.01) and smoking (p < 0.05) were independently associated with the presence of ICA plaques. Multivariate regression analysis revealed that sICAM-1 concentrations in subjects with plaque were negatively associated with the degree of ICA stenosis (p < 0.01) and positively associated with previous cerebral ischemia (p < 0.01), coronary heart disease (p < 0.05) and peripheral artery disease (p < 0.05). In conclusion, elevated sICAM-1 concentrations are independently associated with atherosclerosis of the ICA origin and are predominantly increased in patients with low-grade lesions and with clinical manifestations of vascular disorders.