Percutaneous closure devices do not reduce the risk of major access site complications in patients undergoing elective carotid stent placement

Jennifer S McDonald, David F Kallmes, Giuseppe Lanzino, Harry J. Cloft

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Purpose To examine the risk of femoral access site complications in patients undergoing carotid stent placement who were treated with a closure device compared with patients who were not treated with a closure device. Materials and Methods A national, multihospital patient database, the Premier Perspective database, was used to identify patients hospitalized for carotid stent placement from 2006-2011. To reduce potential selection bias, a propensity score was generated for each patient using relevant clinical variables. Propensity score adjustment via 1:1 matching was performed on patients who did and did not receive a closure device. Primary outcomes were minor femoral access site complications and major complications requiring procedural intervention. Secondary outcomes included in-hospital mortality, stroke, and blood transfusion. Results Among 12,287 patients who underwent carotid stent placement at 217 hospitals, 6,398 (52%) received a closure device on the day of the procedure. After propensity score matching, patients who received a closure device had a lower likelihood of minor access site complications (4.2% vs 5.4%; odds ratio = 0.77; 95% confidence interval, 0.55-0.93; P =.0071) compared with patients who did not receive a closure device; however, this difference was small and likely not clinically relevant. Both groups had a similar risk of major access site complications (P =.32), in-hospital mortality (P =.0520), and stroke (P =.31). Conclusions Use of a closure device was not associated with a substantially reduced risk of major adverse events after carotid stent placement and was associated with only a small improvement in minor access site complications.

Original languageEnglish (US)
Pages (from-to)1057-1062
Number of pages6
JournalJournal of Vascular and Interventional Radiology
Volume24
Issue number7
DOIs
StatePublished - Jul 2013

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Stents
Equipment and Supplies
Propensity Score
Hospital Mortality
Thigh
Stroke
Databases
Selection Bias
Blood Transfusion
Odds Ratio
Confidence Intervals

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Percutaneous closure devices do not reduce the risk of major access site complications in patients undergoing elective carotid stent placement",
abstract = "Purpose To examine the risk of femoral access site complications in patients undergoing carotid stent placement who were treated with a closure device compared with patients who were not treated with a closure device. Materials and Methods A national, multihospital patient database, the Premier Perspective database, was used to identify patients hospitalized for carotid stent placement from 2006-2011. To reduce potential selection bias, a propensity score was generated for each patient using relevant clinical variables. Propensity score adjustment via 1:1 matching was performed on patients who did and did not receive a closure device. Primary outcomes were minor femoral access site complications and major complications requiring procedural intervention. Secondary outcomes included in-hospital mortality, stroke, and blood transfusion. Results Among 12,287 patients who underwent carotid stent placement at 217 hospitals, 6,398 (52{\%}) received a closure device on the day of the procedure. After propensity score matching, patients who received a closure device had a lower likelihood of minor access site complications (4.2{\%} vs 5.4{\%}; odds ratio = 0.77; 95{\%} confidence interval, 0.55-0.93; P =.0071) compared with patients who did not receive a closure device; however, this difference was small and likely not clinically relevant. Both groups had a similar risk of major access site complications (P =.32), in-hospital mortality (P =.0520), and stroke (P =.31). Conclusions Use of a closure device was not associated with a substantially reduced risk of major adverse events after carotid stent placement and was associated with only a small improvement in minor access site complications.",
author = "McDonald, {Jennifer S} and Kallmes, {David F} and Giuseppe Lanzino and Cloft, {Harry J.}",
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T1 - Percutaneous closure devices do not reduce the risk of major access site complications in patients undergoing elective carotid stent placement

AU - McDonald, Jennifer S

AU - Kallmes, David F

AU - Lanzino, Giuseppe

AU - Cloft, Harry J.

PY - 2013/7

Y1 - 2013/7

N2 - Purpose To examine the risk of femoral access site complications in patients undergoing carotid stent placement who were treated with a closure device compared with patients who were not treated with a closure device. Materials and Methods A national, multihospital patient database, the Premier Perspective database, was used to identify patients hospitalized for carotid stent placement from 2006-2011. To reduce potential selection bias, a propensity score was generated for each patient using relevant clinical variables. Propensity score adjustment via 1:1 matching was performed on patients who did and did not receive a closure device. Primary outcomes were minor femoral access site complications and major complications requiring procedural intervention. Secondary outcomes included in-hospital mortality, stroke, and blood transfusion. Results Among 12,287 patients who underwent carotid stent placement at 217 hospitals, 6,398 (52%) received a closure device on the day of the procedure. After propensity score matching, patients who received a closure device had a lower likelihood of minor access site complications (4.2% vs 5.4%; odds ratio = 0.77; 95% confidence interval, 0.55-0.93; P =.0071) compared with patients who did not receive a closure device; however, this difference was small and likely not clinically relevant. Both groups had a similar risk of major access site complications (P =.32), in-hospital mortality (P =.0520), and stroke (P =.31). Conclusions Use of a closure device was not associated with a substantially reduced risk of major adverse events after carotid stent placement and was associated with only a small improvement in minor access site complications.

AB - Purpose To examine the risk of femoral access site complications in patients undergoing carotid stent placement who were treated with a closure device compared with patients who were not treated with a closure device. Materials and Methods A national, multihospital patient database, the Premier Perspective database, was used to identify patients hospitalized for carotid stent placement from 2006-2011. To reduce potential selection bias, a propensity score was generated for each patient using relevant clinical variables. Propensity score adjustment via 1:1 matching was performed on patients who did and did not receive a closure device. Primary outcomes were minor femoral access site complications and major complications requiring procedural intervention. Secondary outcomes included in-hospital mortality, stroke, and blood transfusion. Results Among 12,287 patients who underwent carotid stent placement at 217 hospitals, 6,398 (52%) received a closure device on the day of the procedure. After propensity score matching, patients who received a closure device had a lower likelihood of minor access site complications (4.2% vs 5.4%; odds ratio = 0.77; 95% confidence interval, 0.55-0.93; P =.0071) compared with patients who did not receive a closure device; however, this difference was small and likely not clinically relevant. Both groups had a similar risk of major access site complications (P =.32), in-hospital mortality (P =.0520), and stroke (P =.31). Conclusions Use of a closure device was not associated with a substantially reduced risk of major adverse events after carotid stent placement and was associated with only a small improvement in minor access site complications.

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