Choices of Stent and Cerebral Protection in the Ongoing ACST-2 Trial
Standard
Choices of Stent and Cerebral Protection in the Ongoing ACST-2 Trial : A Descriptive Study. / de Waard, D D; Halliday, A; de Borst, G J; Bulbulia, R; Huibers, A; Casana, R; Bonati, L H; Tolva, V; ACST-2 Collaborative Group.
in: EUR J VASC ENDOVASC, Jahrgang 53, Nr. 5, 05.2017, S. 617-625.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Choices of Stent and Cerebral Protection in the Ongoing ACST-2 Trial
T2 - A Descriptive Study
AU - de Waard, D D
AU - Halliday, A
AU - de Borst, G J
AU - Bulbulia, R
AU - Huibers, A
AU - Casana, R
AU - Bonati, L H
AU - Tolva, V
AU - ACST-2 Collaborative Group
N1 - Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
PY - 2017/5
Y1 - 2017/5
N2 - OBJECTIVE/BACKGROUND: Several plaque and lesion characteristics have been associated with an increased risk for procedural stroke during or shortly after carotid artery stenting (CAS). While technical advancements in stent design and cerebral protection devices (CPD) may help reduce the procedural stroke risk, and anatomy remains important, tailoring stenting procedures according to plaque and lesion characteristics might be a useful strategy in reducing stroke associated with CAS. In this descriptive report of the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), it was assessed whether choice for stent and use or type of CPD was influenced by plaque and lesion characteristics.METHODS: Trial patients who underwent CAS between 2008 and 2015 were included in this study. Chi-square statistics were used to study the effects of plaque echolucency, ipsilateral preocclusive disease (90-99%), and contralateral high-grade stenosis (>50%) or occlusion of the carotid artery on interventionalists' choice for stent and CPD. Differences in treatment preference between specialties were also analysed.RESULTS: In this study, 831 patients from 88 ACST-2 centres were included. Almost all procedures were performed by either interventional radiologists (50%) or vascular surgeons (45%). Plaque echolucency, ipsilateral preocclusive disease (90-99%), and significant contralateral stenosis (>50%) or occlusion did not affect the choice of stent or either the use of cerebral protection and type of CPD employed (i.e., filter/flow reversal). Vascular surgeons used a CPD significantly more often than interventional radiologists (98.6% vs. 76.3%; p < .001), but this choice did not appear to be dependent on patient characteristics.CONCLUSION: In ACST-2, plaque characteristics and severity of stenosis did not primarily determine interventionalists' choice of stent or use or type of CPD, suggesting that other factors, such as vascular anatomy or personal and centre preference, may be more important. Stent and CPD use was highly heterogeneous among participating European centres.
AB - OBJECTIVE/BACKGROUND: Several plaque and lesion characteristics have been associated with an increased risk for procedural stroke during or shortly after carotid artery stenting (CAS). While technical advancements in stent design and cerebral protection devices (CPD) may help reduce the procedural stroke risk, and anatomy remains important, tailoring stenting procedures according to plaque and lesion characteristics might be a useful strategy in reducing stroke associated with CAS. In this descriptive report of the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), it was assessed whether choice for stent and use or type of CPD was influenced by plaque and lesion characteristics.METHODS: Trial patients who underwent CAS between 2008 and 2015 were included in this study. Chi-square statistics were used to study the effects of plaque echolucency, ipsilateral preocclusive disease (90-99%), and contralateral high-grade stenosis (>50%) or occlusion of the carotid artery on interventionalists' choice for stent and CPD. Differences in treatment preference between specialties were also analysed.RESULTS: In this study, 831 patients from 88 ACST-2 centres were included. Almost all procedures were performed by either interventional radiologists (50%) or vascular surgeons (45%). Plaque echolucency, ipsilateral preocclusive disease (90-99%), and significant contralateral stenosis (>50%) or occlusion did not affect the choice of stent or either the use of cerebral protection and type of CPD employed (i.e., filter/flow reversal). Vascular surgeons used a CPD significantly more often than interventional radiologists (98.6% vs. 76.3%; p < .001), but this choice did not appear to be dependent on patient characteristics.CONCLUSION: In ACST-2, plaque characteristics and severity of stenosis did not primarily determine interventionalists' choice of stent or use or type of CPD, suggesting that other factors, such as vascular anatomy or personal and centre preference, may be more important. Stent and CPD use was highly heterogeneous among participating European centres.
KW - Asymptomatic Diseases
KW - Carotid Stenosis
KW - Cerebrovascular Circulation
KW - Cerebrovascular Disorders
KW - Chi-Square Distribution
KW - Clinical Decision-Making
KW - Embolic Protection Devices
KW - Endarterectomy, Carotid
KW - Endovascular Procedures
KW - Humans
KW - Patient Selection
KW - Plaque, Atherosclerotic
KW - Practice Patterns, Physicians'
KW - Prosthesis Design
KW - Risk Factors
KW - Severity of Illness Index
KW - Stents
KW - Time Factors
KW - Treatment Outcome
KW - Comparative Study
KW - Journal Article
KW - Multicenter Study
KW - Randomized Controlled Trial
U2 - 10.1016/j.ejvs.2016.12.034
DO - 10.1016/j.ejvs.2016.12.034
M3 - SCORING: Journal article
C2 - 28291675
VL - 53
SP - 617
EP - 625
JO - EUR J VASC ENDOVASC
JF - EUR J VASC ENDOVASC
SN - 1078-5884
IS - 5
ER -