Ralf Langhoff1, Joachim Schofer2, Dierk Scheinert3, Andrej Schmidt3, Gerald Sedgewick4, Elizabeth Saylors5, Ravish Sachar6, Horst Sievert7, Thomas Zeller8. 1. Department of Angiology, Sankt Gertrauden Krankenhaus GmbH, Berlin, Germany. Electronic address: ralf.langhoff@sankt-gertrauden.de. 2. Department of Cardiology, Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg, Germany. 3. Clinic for Angiology, University Hospital Leipzig, Leipzig, Germany. 4. Imaging and Analysis, LLC, St. Paul, Minnesota. 5. Contego Medical, LLC, Raleigh, North Carolina. 6. Heart and Vascular Services, UNC REX Healthcare, Raleigh, North Carolina. 7. CardioVascular Center Frankfurt, Frankfurt am Main, Germany; Anglia Ruskin University, Chelmsford, United Kingdom. 8. Department of Angiology, Universitats Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany.
Abstract
OBJECTIVES: This study evaluated the safety and performance of the Paladin System, a novel angioplasty balloon with an integrated embolic protection filter designed to increase embolic protection during post-dilation. BACKGROUND: The risk of major adverse events during carotid artery stenting (CAS) is equivalent to carotid endarterectomy. However, the risk of minor stroke remains higher with CAS. Much of this risk occurs during post-stent dilation. METHODS: A total of 106 patients were enrolled in 5 centers in Germany. The study's primary endpoint was all-cause death, myocardial infarction, and stroke at 30 days post-procedure. Pre- and post-procedural diffusion-weighted magnetic resonance imaging evaluated new ischemic lesions in 30 subjects. Filter histomorphometric analysis was performed in 23 patients. Retrospective analyses compared outcome rates to historical controls. RESULTS: Device and procedural success rates were 100%. The combined major adverse event rate (death, myocardial infarction, and stroke) at discharge and at 30 days was 0% and 1.0%, respectively. The single adverse event was a stroke, which occurred at day 12 and was believed unrelated to the device or procedure. New ischemic lesions were found in 11 (36.7%) patients in the diffusion-weighted magnetic resonance imaging subset. New ipsilateral lesions were seen in 9 (30.0%) patients. Mean lesion volume per patient was 0.010 cm3. Debris was present in all filters, and approximately 90% of captured particles were <100 μm. CONCLUSIONS: Use of the Paladin System for post-stent dilation during CAS appears safe, and it may effectively decrease the number of embolic particles reaching the brain, which may help reduce the risk of procedure-related stroke. (A Multi-Center Study to Evaluate Acute Safety and Clinical Performance of Paladin® Carotid Post-Dilation Balloon System With Integrated Embolic Protection; NCT02501148).
OBJECTIVES: This study evaluated the safety and performance of the Paladin System, a novel angioplasty balloon with an integrated embolic protection filter designed to increase embolic protection during post-dilation. BACKGROUND: The risk of major adverse events during carotid artery stenting (CAS) is equivalent to carotid endarterectomy. However, the risk of minor stroke remains higher with CAS. Much of this risk occurs during post-stent dilation. METHODS: A total of 106 patients were enrolled in 5 centers in Germany. The study's primary endpoint was all-cause death, myocardial infarction, and stroke at 30 days post-procedure. Pre- and post-procedural diffusion-weighted magnetic resonance imaging evaluated new ischemic lesions in 30 subjects. Filter histomorphometric analysis was performed in 23 patients. Retrospective analyses compared outcome rates to historical controls. RESULTS: Device and procedural success rates were 100%. The combined major adverse event rate (death, myocardial infarction, and stroke) at discharge and at 30 days was 0% and 1.0%, respectively. The single adverse event was a stroke, which occurred at day 12 and was believed unrelated to the device or procedure. New ischemic lesions were found in 11 (36.7%) patients in the diffusion-weighted magnetic resonance imaging subset. New ipsilateral lesions were seen in 9 (30.0%) patients. Mean lesion volume per patient was 0.010 cm3. Debris was present in all filters, and approximately 90% of captured particles were <100 μm. CONCLUSIONS: Use of the Paladin System for post-stent dilation during CAS appears safe, and it may effectively decrease the number of embolic particles reaching the brain, which may help reduce the risk of procedure-related stroke. (A Multi-Center Study to Evaluate Acute Safety and Clinical Performance of Paladin® Carotid Post-Dilation Balloon System With Integrated Embolic Protection; NCT02501148).
Authors: Piotr Pieniążek; Przemysław Nowakowski; Krzysztof Ziaja; Adam Kobayashi; Wojciech Uchto; Jakub Sulżenko; Roman Machnik; Łukasz Tekieli; Dariusz Stańczyk; Krzysztof Plens; Wojciech Zasada; Artur Dziewierz; Damian Ziaja Journal: Postepy Kardiol Interwencyjnej Date: 2019-12-31 Impact factor: 1.426