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Use of an embolic protection device during carotid artery stenting is associated with lower periprocedural risk
  1. Christoph Knappich,
  2. Bianca Bohmann,
  3. Felix Kirchhoff,
  4. Vanessa Lohe,
  5. Shamsun Naher,
  6. Michael Kallmayer,
  7. Hans-Henning Eckstein,
  8. Andreas Kuehnl
    1. Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
    1. Correspondence to Dr Christoph Knappich, Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany; christoph.knappich{at}googlemail.com

    Abstract

    Objective To investigate associations between individual embolic protection device (EPD) use and respective center policy with periprocedural outcomes after carotid artery stenting (CAS).

    Methods This 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 as routine EPD (>90%), selective EPD (10–90%), or sporadic EPD (<10%) centers. Primary study outcome was in-hospital stroke or death. Univariate and multivariate regression analyses were performed.

    Results Overall, 19 302 patients who had undergone CAS between 2013 and 2016 were included. The highest in-hospital stroke or death rate was found in sporadic EPD centers, followed by selective and routine EPD centers (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 EPD centers showed a significantly lower in-hospital mortality compared with sporadic EPD centers (aOR=0.44; 95% CI 0.22 to 0.88).

    Conclusions In 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.

    • Stroke
    • Stent
    • Angioplasty
    • Cervical
    • Embolic

    Data availability statement

    Data sharing not applicable as no datasets generated and/or analyzed for this study. All data are saved on IQTIG servers. Data access was only permitted using controlled remote data processing.

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    Data availability statement

    Data sharing not applicable as no datasets generated and/or analyzed for this study. All data are saved on IQTIG servers. Data access was only permitted using controlled remote data processing.

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    Footnotes

    • Contributors CK: Conceptualization, Methodology, Validation, Writing - Original Draft, Writing - Review and Editing. BB: conceptualization, methodology, software, validation, formal analysis, data curation, writing - review and editing, visualization. FK: methodology, validation, writing - review and editing. VL: conceptualization, methodology, validation, data curation, writing - review and editing. SN: validation, formal analysis, data curation, writing - review and editing, visualization. MK: conceptualization, methodology, validation, writing - review and editing. H-HE: conceptualization, methodology, resources, writing - review and editing, supervision, project administration, funding acquisition. AK: conceptualization, methodology, validation, formal analysis, resources, writing - original draft, writing - review and editing, supervision, project administration, funding acquisition. All authors reviewed and edited the manuscript and approved the final manuscript. AK acts as the guarantor of this study.

    • Funding The research project was funded by the Germany’s Federal Joint Committee Innovation Fund, funding reference number 01VSF19016.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.