PMID- 23265587
OWN - NLM
STAT- MEDLINE
DCOM- 20130314
LR  - 20130122
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 57
IP  - 2
DP  - 2013 Feb
TI  - Assessing the impact of distal protection filter design characteristics on 30-day 
      outcomes of carotid artery stenting procedures.
PG  - 309-317.e2
LID - S0741-5214(12)01931-3 [pii]
LID - 10.1016/j.jvs.2012.08.113 [doi]
AB  - OBJECTIVE: This study aims to review retrospectively the records of patients 
      treated with carotid artery stenting (CAS) to investigate the potential 
      correlations between clinical variables, distal protection filter (DPF) type and 
      characteristics, and 30-day peri-/postprocedural outcomes. METHODS: This is a 
      multicenter, single-arm, nonrandomized retrospective study of patients who 
      underwent filter-protected CAS in the Pittsburgh, Pennsylvania, region between 
      July 2000 and May 2011. Analysis of peri-/postprocedural complications included 
      myocardial infarction, transient ischemic attacks (TIA), stroke, death, and a 
      composition of all adverse events (AEs). Filter characteristics for Accunet 
      (Abbott Vascular, Santa Clara, Calif; n = 429 [58.8%]), Angioguard (Cordis 
      Endovascular, Miami Lakes, Fla; n = 114 [15.6%]), FilterWire (Boston Scientific, 
      Natick, Mass; n = 113 [15.5%]), Spider (ev3 Endovascular, Plymouth, Minn; n = 45 
      [6.2%]), and Emboshield (Abbott Vascular; n = 24 [3.3%]) were previously 
      determined in vitro and were used to find correlations with CAS procedural 
      outcomes. Both univariate and multivariate analyses were performed, as well as 
      goodness-of-fit tests to find multivariate correlations with procedural outcomes. 
      RESULTS: In total, 731 CAS procedures using six different DPFs were analyzed. 
      Peri-/postprocedural AEs included 19 TIAs (2.6%), 38 strokes (5.2%), one 
      myocardial infarction (0.1%), 19 deaths (3.6%), and a total of 61 patients with 
      complications (8.3%). Univariate analysis for filter design characteristics 
      showed that the composite of AE was negatively associated with both vascular 
      resistance (P = .01) and eccentricity (P = .02) and was positively associated 
      with porosity (P = .0007), number of pores (P = .005), and pore density (P = 
      .001). Multivariate analysis and the goodness-of-fit test revealed that patients 
      with a history of congestive heart failure, stroke, and TIA (each with odds ratio 
      >1) led to a good-fit model P value of .72 for peri-/postprocedural AEs. 
      Multivariate analysis was inconclusive for all filter design characteristics. 
      CONCLUSIONS: The following filter design characteristics are independently 
      significant for minimizing peri-/postprocedural AEs: higher vascular resistance, 
      concentric in shape, greater capture efficiency, lower porosity, lower number of 
      pores, and lower pore density. Lower porosity and smaller wall apposition were 
      also found to be independently significant for minimization of 
      peri-/postprocedural TIAs. This information can be used when considering the 
      desirable design characteristics of future DPFs.).
CI  - Copyright (c) 2013 Society for Vascular Surgery. Published by Mosby, Inc. All 
      rights reserved.
FAU - Loghmanpour, Natasha A
AU  - Loghmanpour NA
AD  - Biomedical Engineering Department, Carnegie Mellon University, Pittsburgh, PA, 
      USA.
FAU - Siewiorek, Gail M
AU  - Siewiorek GM
FAU - Wanamaker, Kelly M
AU  - Wanamaker KM
FAU - Muluk, Satish C
AU  - Muluk SC
FAU - Chaer, Rabih
AU  - Chaer R
FAU - Wholey, Mark H
AU  - Wholey MH
FAU - Finol, Ender A
AU  - Finol EA
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20121221
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Angioplasty/adverse effects/*instrumentation/mortality
MH  - Carotid Artery 
      Diseases/complications/diagnosis/mortality/physiopathology/*therapy
MH  - Chi-Square Distribution
MH  - *Embolic Protection Devices
MH  - Female
MH  - Humans
MH  - Ischemic Attack, Transient/etiology
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Myocardial Infarction/etiology
MH  - Odds Ratio
MH  - Pennsylvania
MH  - Porosity
MH  - Prosthesis Design
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - *Stents
MH  - Stroke/etiology
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vascular Resistance
EDAT- 2012/12/26 06:00
MHDA- 2013/03/15 06:00
CRDT- 2012/12/26 06:00
PHST- 2012/06/02 00:00 [received]
PHST- 2012/08/20 00:00 [revised]
PHST- 2012/08/22 00:00 [accepted]
PHST- 2012/12/26 06:00 [entrez]
PHST- 2012/12/26 06:00 [pubmed]
PHST- 2013/03/15 06:00 [medline]
AID - S0741-5214(12)01931-3 [pii]
AID - 10.1016/j.jvs.2012.08.113 [doi]
PST - ppublish
SO  - J Vasc Surg. 2013 Feb;57(2):309-317.e2. doi: 10.1016/j.jvs.2012.08.113. Epub 2012 
      Dec 21.