Kobayashi Taisei, Giri Jay
Cardiovascular Division, University of Pennsylvania; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania.
Cardiovascular Division, University of Pennsylvania; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania.
Prog Cardiovasc Dis. 2017 May-Jun;59(6):612-618. doi: 10.1016/j.pcad.2017.03.003. Epub 2017 Mar 31.
Embolic protection device (EPD) use has become ubiquitous and is currently mandated by the Centers for Medicare and Medicaid (CMS) for reimbursement in conjunction with carotid artery stenting (CAS). There are two classes of EPD devices: distal filter EPD (f-EPD) and proximal EPD (p-EPD). Measuring the incremental benefit of one strategy over the other remains problematic for several reasons. The first lies in the difficulty of defining an embolic event as transcranial Doppler and diffusion-weighted magnetic resonance imaging abnormalities may not correlate with clinical events. Next, f-EPD is used more frequently than p-EPD making direct comparisons challenging, as analyses to this point have been underpowered. However, there are several promising emerging techniques and technologies that warrant further investigation.
栓子保护装置（EPD）的使用已变得十分普遍，目前医疗保险和医疗补助服务中心（CMS）规定，在进行颈动脉支架置入术（CAS）时使用该装置可获得报销。EPD装置有两类：远端滤网式栓子保护装置（f-EPD）和近端栓子保护装置（p-EPD）。由于多种原因，衡量一种策略相对于另一种策略的增量效益仍然存在问题。首先，将栓塞事件定义存在困难，因为经颅多普勒和扩散加权磁共振成像异常可能与临床事件不相关。其次，f-EPD的使用频率高于p-EPD，这使得直接比较具有挑战性，因为到目前为止的分析力度不足。然而，有几种有前景的新兴技术值得进一步研究。
