Rate Of In-hospital Stroke In Trans-femoral Carotid Stenting Without Embolic Protection Device
Peter A. Soden, MD1, Patric Liang, MD1, Sara Zettervall, MD1, Andy Lee, MD1, Ruby Lo, MD2, Marc Schermerhorn, MD1.
1Beth Israel Deaconess Hospital, Boston, MA, USA, 2Rhode Island Hospital, Providence, RI, USA.
Objectives Despite recommendations for use of embolic protection devices (EPD) in trans-femoral carotid stenting (tfCAS) there has been a lack of supporting evidence for its practice. Therefore we sought to quantify the risk associated with no EPD. Methods We analyzed all tfCAS procedures for first-time intervention related to stenosis in the Vascular Quality Initiative registry from 2005-2018. EPD was stratified as successful use of EPD, not attempted, and attempted but failed. Adjusted analysis was performed to adjust for symptom status as well as baseline characteristics. Results 18,121 tfCAS were performed during this period, 93% successful EPD, 4% with no EPD attempted, and 3% with failed EPD, with 60%, 69%, and 61% respectively being performed for symptomatic stenosis. Over time there was a steady rate of no EPD use ranging from 2.1-5.3% since 2010. The in-hospital stroke rates were 1.9%, 5.3%, and 5.6% (P<.001) respectively for successful EPD, no EPD attempted, and failed EPD attempt. The stroke-death rate was 2.5%, 8.8%, and 6.0% (P<.001) respectively as well. For asymptomatic patients the stroke rate was 1.1% for successful EPD, 3.1% for no EPD attempted, and 4.0% for failed EPD (P<.001) and the stroke/death rate was 1.2%, 4.0%, and 4.0% (P<.001) respectively. On adjusted analysis no EPD attempted was associated with 2-3x higher risk of in-hospital stroke when compared to successful EPD (OR 2.7, 95% CI 1.8-4.1), and failed EPD was similarly associated with a 2-3x higher risk of stroke (2.6, 1.4-5.0). Conclusion The risk of in-hospital stroke is 2-3 times higher when none or failed EPD use occurs in tfCAS, even after adjustment for symptom status. Strong consideration should be given to stopping a trans-femoral procedure for asymptomatic disease if an EPD cannot be placed.
Back to 2020 ePosters