Use of an embolic protection device during carotid artery stenting is associated with lower periprocedural risk

Abstract

ObjectiveTo investigate associations between individual embolic protection device (EPD) use and respective center policy with periprocedural outcomes after carotid artery stenting (CAS).MethodsThis analysis is based on the nationwide German statutory quality assurance database and was funded by Germany’s Federal Joint Committee Innovation Fund (G-BA Innovationsfonds, 01VSF19016 ISAR-IQ). According to their policy towards EPD use, hospitals were categorized asroutine EPD(>90%),selective EPD(10–90%), orsporadic EPD(<10%)centers. Primary study outcome was in-hospital stroke or death. Univariate and multivariate regression analyses were performed.ResultsOverall, 19 302 patients who had undergone CAS between 2013 and 2016 were included. The highest in-hospital stroke or death rate was found insporadic EPDcenters, followed byselectiveandroutine EPDcenters (3.1% vs 2.9% vs 1.8%; P<0.001). Across the whole cohort, EPD use was associated with a lower in-hospital stroke or death rate (OR=0.60; 95% CI 0.50 to 0.72). In the multivariate regression analysis, EPD use was independently associated with a lower in-hospital stroke rate (aOR=0.66; 95% CI 0.46 to 0.94). Regarding center policy,routine EPDcenters showed a significantly lower in-hospital mortality compared withsporadic EPDcenters (aOR=0.44; 95% CI 0.22 to 0.88).ConclusionsIn a contemporary real-world cohort with low risk of selection bias, EPD use was associated with a lower in-hospital risk of stroke. A center policy of routine EPD use was associated with lower mortality. These data support routine use of EPD during CAS to enhance patient safety.