Zahn Ralf, Ischinger Thomas, Mark Bernd, Gass Sabine, Zeymer Uwe, Schmalz Wolfgang, Haerten Klaus, Hauptmann Karl Eugen, von Leitner Enz-Rüdiger, Kasper Wolfgang, Tebbe Ulrich, Senges Jochen
Herzzentrum, Kardiologie, Ludwigshafen, Germany.
J Am Coll Cardiol. 2005 Jun 7;45(11):1769-74. doi: 10.1016/j.jacc.2005.02.067.
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).
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.
We analyzed data from the Carotid Artery Stent (CAS) Registry.
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).
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.
我们旨在比较滤器式栓子保护装置（F-EPD）和远端闭塞式栓子保护装置（DO-EPD）在接受颈动脉支架置入术（CAS）患者中的疗效。
栓子保护装置（EPD）可能会降低CAS围手术期脑缺血事件的发生率。然而，不同类型的EPD在有效性上是否存在差异尚不清楚。
我们分析了来自颈动脉支架置入术（CAS）注册研究的数据。
从1996年7月至2003年7月，前瞻性CAS注册研究纳入了1734例患者。其中，729例患者接受了EPD治疗，553例（75.9%）接受了F-EPD治疗，176例（24.1%）接受了DO-EPD治疗。接受DO-EPD治疗的患者更有可能因症状性狭窄而接受治疗（64.5%对53.4%，p = 0.011）。如溃疡比例更高（p = 0.035）、严重钙化比例更高（p = 0.039）、病变长度更长（p = 0.025）以及介入前狭窄分级更高（p < 0.001）所示，接受DO-EPD治疗患者的颈动脉病变似乎更复杂。DO-EPD组CAS干预的中位持续时间为30分钟，而滤器组为48分钟（p < 0.001）。两组保护装置在临床事件发生率上未观察到差异。对院内死亡或卒中联合终点事件发生情况的多变量分析发现，滤器式和DO-EPD之间无差异（DO-EPD组176例中有4例[2.3%]，F-EPD组551例中有10例[1.8%]；调整后的优势比 = 1.04，95%置信区间0.24至4.44；p = 0.958）。
滤器式EPD是目前临床实践中EPD的首选方法。在CAS期间，F-EPD和DO-EPD似乎同样有效。
