Embolic protection devices for carotid artery stenting: better results than stenting without protection?
Identifieur interne : 001920 ( Main/Exploration ); précédent : 001919; suivant : 001921Embolic protection devices for carotid artery stenting: better results than stenting without protection?
Auteurs : Ralf Zahn [Allemagne] ; Bernd Mark [Allemagne] ; Nikolaj Niedermaier [Allemagne] ; Uwe Zeymer [Allemagne] ; Peter Limbourg [Allemagne] ; Thomas Ischinger [Allemagne] ; Klaus Haerten [Allemagne] ; Karl Eugen Hauptmann [Allemagne] ; Enz-Ru Diger Von Leitner [Allemagne] ; Wolfgang Kasper [Allemagne] ; Ulrich Tebbe [Allemagne] ; Jochen Senges [Allemagne]Source :
- European Heart Journal [ 0195-668X ] ; 2004-09-01.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
Abstract
Aims Carotid artery stenting (CAS) for carotid artery stenoses has become an alternative to carotid endarterectomy. However, CAS itself can cause cerebral ischaemic events. Embolic protection devices (PD) promise to reduce the incidence of these events. Methods and results From July 1996 to March 2003, 1483 patients from 26 hospitals were included in the prospective CAS Registry of the ALKK study group. A PD was used in 668 of 1483 patients (45%). The use of a PD has grown rapidly over the years and reached 100% in 2003. Patients treated with a PD had prior carotid artery dilatation more often (3.5% versus 1%, p<0.001), a prior myocardial infarction (34% versus 27.4%, p=0.007) and a history of arterial hypertension (89.9% versus 78.6%, p=0.007) compared to patients treated without a PD. A thrombus was more often visible in patients treated under distal protection (16.5% versus 8%, p<0.001). The use of a PD led to a 10-min longer intervention (45 min versus 35 min median, p<0.001). Patients treated with a PD had a lower rate of ipsilateral stroke (1.7% versus 4.1%, p=0.007) and a lower rate of all non-fatal strokes and all deaths (2.1% versus 4.9%, p=0.004) during the hospital stay. This was confirmed by multiple logistic regression analysis (adjusted OR=0.45, 95% CI: 0.23–0.91, p=0.026). A similar reduction could be found for symptomatic as well as asymptomatic carotid artery stenoses. Conclusion Since 1996 there has been a steady increase in the use of PDs for CAS, with a 100% use in 2003. The use of a PD may lower the rate of ipsilateral strokes during CAS.
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DOI: 10.1016/j.ehj.2004.06.018
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first="Thomas" last="Ischinger">Thomas Ischinger</name><affiliation wicri:level="1"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Städtisches Klinikum, Kardiologie, München-Bogenhausen</wicri:regionArea><wicri:noRegion>München-Bogenhausen</wicri:noRegion><wicri:noRegion>München-Bogenhausen</wicri:noRegion></affiliation></author><author><name sortKey="Haerten, Klaus" sort="Haerten, Klaus" uniqKey="Haerten K" first="Klaus" last="Haerten">Klaus Haerten</name><affiliation wicri:level="1"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Marienkrankenhaus, Kardiologie, Wesel</wicri:regionArea><wicri:noRegion>Wesel</wicri:noRegion><wicri:noRegion>Wesel</wicri:noRegion></affiliation></author><author><name sortKey="Hauptmann, Karl Eugen" sort="Hauptmann, Karl Eugen" uniqKey="Hauptmann K" first="Karl Eugen" last="Hauptmann">Karl Eugen Hauptmann</name><affiliation wicri:level="1"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Krankenhaus der Barmherzigen Brüder, Kardiologie, Trier</wicri:regionArea><wicri:noRegion>Trier</wicri:noRegion><wicri:noRegion>Trier</wicri:noRegion></affiliation></author><author><name sortKey="Leitner, Enz Ru Diger Von" sort="Leitner, Enz Ru Diger Von" uniqKey="Leitner E" first="Enz-Ru Diger Von" last="Leitner">Enz-Ru Diger Von Leitner</name><affiliation wicri:level="3"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Klinikum Siloah, Kardiologie, Hannover</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Hanovre</settlement></placeName></affiliation></author><author><name sortKey="Kasper, Wolfgang" sort="Kasper, Wolfgang" uniqKey="Kasper W" first="Wolfgang" last="Kasper">Wolfgang Kasper</name><affiliation wicri:level="1"><country xml:lang="fr">Allemagne</country><wicri:regionArea>St. Josefs Hospital, Kardiologie, Wiesbaden</wicri:regionArea><wicri:noRegion>Wiesbaden</wicri:noRegion><wicri:noRegion>Wiesbaden</wicri:noRegion></affiliation></author><author><name sortKey="Tebbe, Ulrich" sort="Tebbe, Ulrich" uniqKey="Tebbe U" first="Ulrich" last="Tebbe">Ulrich Tebbe</name><affiliation wicri:level="1"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Klinikum Lippe-Detmold, Kardiologie, Detmold</wicri:regionArea><wicri:noRegion>Detmold</wicri:noRegion><wicri:noRegion>Detmold</wicri:noRegion></affiliation></author><author><name sortKey="Senges, Jochen" sort="Senges, Jochen" uniqKey="Senges J" first="Jochen" last="Senges">Jochen Senges</name><affiliation wicri:level="1"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Herzzentrum, Kardiologie, Ludwigshafen</wicri:regionArea><wicri:noRegion>Ludwigshafen</wicri:noRegion><wicri:noRegion>Ludwigshafen</wicri:noRegion></affiliation></author></analytic><monogr></monogr><series><title level="j">European Heart Journal</title><title level="j" type="abbrev">Eur Heart J</title><idno type="ISSN">0195-668X</idno><idno type="eISSN">1522-9645</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2004-09-01">2004-09-01</date><biblScope unit="volume">25</biblScope><biblScope unit="issue">17</biblScope><biblScope unit="page" from="1550">1550</biblScope><biblScope unit="page" to="1558">1558</biblScope></imprint><idno type="ISSN">0195-668X</idno></series><idno type="istex">1DC6C4C4BA06DCE56280DE18A06A1B5E61B82E68</idno><idno type="DOI">10.1016/j.ehj.2004.06.018</idno><idno type="PII">S0195-668X(04)00418-X</idno><idno type="local">D128</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0195-668X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Angioplasty</term><term>Carotid</term><term>Device</term><term>Instrumental dilatation</term><term>Instrumentation therapy</term><term>Protection</term><term>Result</term><term>Stent</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Angioplastie</term><term>Carotide</term><term>Dilatation instrumentale</term><term>Dispositif</term><term>Protection</term><term>Résultat</term><term>Stent</term><term>Traitement instrumental</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Aims Carotid artery stenting (CAS) for carotid artery stenoses has become an alternative to carotid endarterectomy. However, CAS itself can cause cerebral ischaemic events. Embolic protection devices (PD) promise to reduce the incidence of these events. Methods and results From July 1996 to March 2003, 1483 patients from 26 hospitals were included in the prospective CAS Registry of the ALKK study group. A PD was used in 668 of 1483 patients (45%). The use of a PD has grown rapidly over the years and reached 100% in 2003. Patients treated with a PD had prior carotid artery dilatation more often (3.5% versus 1%, p<0.001), a prior myocardial infarction (34% versus 27.4%, p=0.007) and a history of arterial hypertension (89.9% versus 78.6%, p=0.007) compared to patients treated without a PD. A thrombus was more often visible in patients treated under distal protection (16.5% versus 8%, p<0.001). The use of a PD led to a 10-min longer intervention (45 min versus 35 min median, p<0.001). Patients treated with a PD had a lower rate of ipsilateral stroke (1.7% versus 4.1%, p=0.007) and a lower rate of all non-fatal strokes and all deaths (2.1% versus 4.9%, p=0.004) during the hospital stay. This was confirmed by multiple logistic regression analysis (adjusted OR=0.45, 95% CI: 0.23–0.91, p=0.026). A similar reduction could be found for symptomatic as well as asymptomatic carotid artery stenoses. Conclusion Since 1996 there has been a steady increase in the use of PDs for CAS, with a 100% use in 2003. The use of a PD may lower the rate of ipsilateral strokes during CAS.</div></front></TEI><affiliations><list><country><li>Allemagne</li></country><region><li>Basse-Saxe</li></region><settlement><li>Hanovre</li></settlement></list><tree><country name="Allemagne"><noRegion><name sortKey="Zahn, Ralf" sort="Zahn, Ralf" uniqKey="Zahn R" first="Ralf" last="Zahn">Ralf Zahn</name></noRegion><name sortKey="Haerten, Klaus" sort="Haerten, Klaus" uniqKey="Haerten K" first="Klaus" last="Haerten">Klaus Haerten</name><name sortKey="Hauptmann, Karl Eugen" sort="Hauptmann, Karl Eugen" uniqKey="Hauptmann K" first="Karl Eugen" last="Hauptmann">Karl Eugen Hauptmann</name><name sortKey="Ischinger, Thomas" sort="Ischinger, Thomas" uniqKey="Ischinger T" first="Thomas" last="Ischinger">Thomas Ischinger</name><name sortKey="Kasper, Wolfgang" sort="Kasper, Wolfgang" uniqKey="Kasper W" first="Wolfgang" last="Kasper">Wolfgang Kasper</name><name sortKey="Leitner, Enz Ru Diger Von" sort="Leitner, Enz Ru Diger Von" uniqKey="Leitner E" first="Enz-Ru Diger Von" last="Leitner">Enz-Ru Diger Von Leitner</name><name sortKey="Limbourg, Peter" sort="Limbourg, Peter" uniqKey="Limbourg P" first="Peter" last="Limbourg">Peter Limbourg</name><name sortKey="Mark, Bernd" sort="Mark, Bernd" uniqKey="Mark B" first="Bernd" last="Mark">Bernd Mark</name><name sortKey="Niedermaier, Nikolaj" sort="Niedermaier, Nikolaj" uniqKey="Niedermaier N" first="Nikolaj" last="Niedermaier">Nikolaj Niedermaier</name><name sortKey="Senges, Jochen" sort="Senges, Jochen" uniqKey="Senges J" first="Jochen" last="Senges">Jochen Senges</name><name sortKey="Tebbe, Ulrich" sort="Tebbe, Ulrich" uniqKey="Tebbe U" first="Ulrich" last="Tebbe">Ulrich Tebbe</name><name sortKey="Zeymer, Uwe" sort="Zeymer, Uwe" uniqKey="Zeymer U" first="Uwe" last="Zeymer">Uwe Zeymer</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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