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Introduction: Despite advances in coronary stent design, restenosis and thrombosis remain rare but potentially serious complications that may be related to stent malapposition and longitudinal deformation. As such, the aim of this study was to evaluate stent apposition, tissue coverage and longitudinal deformation in two second-generation everolimus-eluting stents (EES) with serial optical coherence tomography (OCT). Methods: Sixty patients recruited from 5 interventional cardiology centers were randomized (1:1) to receive either the cobalt-chromium (CoCr) EES or platinum-chromium (PtCr) EES (n=30 in each group). Patients had OCT imaging after nominal and high-pressure post-dilation and at 6 months, with 12 month clinical follow up. Strut apposition and stent length were measured by OCT at each time point. The primary endpoint was the percentage of struts malapposed before and after optimal post-dilation. Secondary OCT endpoints were percent of struts apposed and covered at 6 months and percent change in stent length, classified as mild (10%). Results: All results are presented as CoCr-EES versus PtCr-EES. A total of 38,948 struts were analysed by OCT. After nominal dilation, the percent of malapposed struts was 12.4% versus 15.8% (p=0.34). After post-dilation the percentage malapposition was 9.5% versus 10% (p=0.81). At 6 months, the percentage of struts covered and apposed was 81.7% versus 81% (p=0.87). There was no significant difference between groups in the mean change in stent length (nominal: 6.38% versus 4.26%, p=0.24; post-dilation: 4.18% versus 4.97%, p=0.52; 6 months: 6.91% versus 8.61%, p=0.49). However, at 6 months the PtCr-EES manifested significantly more cases of severe change in stent length (>10%) than the CoCr-EES (2 versus 8 cases, p=0.03) but were not associated with adverse clinical events during the study period. Conclusions: Both CoCr-EES and PtCr-EES stents demonstrate high rates of apposition and tissue coverage over 6 months with no significant differences in clinical outcomes. The PtCr-EES stent may be more susceptible to late stent deformation at 6 months but the true incidence, mechanisms, and clinical significance are as yet unclear.

Background: Carotid endarterectomy (CEA) has long been known to be an effective procedure for stroke prevention in patients with symptomatic carotid artery stenosis. However, its best practice has been in evolution with more recent evidence regarding optimal surgical timing, patient selection and choice of endovascular intervention versus surgery. Understanding the changes in CEA practice over time provides insights into how successfully evidence from research is translated into clinical practice. Objective: To investigate changes in practice and outcome of CEA over time in an Australian stroke centre hospital. Hypothesis: We hypothesized that the practice of CEA would change in line with new evidence in medical literature. Methods: All patients who underwent CEA from 2004-14 and carotid angioplasty and stenting (CAS) from 2003-08 were included. Clinical data were analysed to identify time trends in choice of intervention, patient selection, pre-operative imaging utilization, surgical timing and outcome. Chi square test, Mann-Whitney U test and multivariable logistic regression models were used in statistical analysis. Results: There were 510 CEA performed in 2004-14 and 95 CAS in 2003-08. The proportion of patients undergoing CEA increased from 60% to 90% from 2004-08 (p80 years old increased (p=0.001) and the proportion of asymptomatic patients decreased (OR 0.9 [0.87,0.99] p=0.003) over time. Median time from symptom onset to surgery decreased from 52 days (Q1: 25, Q3: 74) in 2004 to 8 days (Q1: 5, Q3: 37) in 2014 (p Conclusions: The trends in CEA practice at our institute align with international trends and guidelines. This result may provide a representative indicator of Australian hospital practice.

More than 1.2 million percutaneous coronary interventions are performed annually in the United States, with only an estimated 33% performed in women, despite the established benefits of percutaneous coronary intervention and adjunctive pharmacotherapy in reducing fatal and nonfatal ischemic complications in acute myocardial infarction and high-risk acute coronary syndromes. This statement reviews sex-specific data on the safety and efficacy of contemporary interventional therapies in women.

Background and Purpose — Ambulatory procedures increase patient comfort and enhance cost-effectiveness. We sought to determine the feasibility and safety of ambulatory carotid stenting. Methods — A selected group of patients was admitted and discharged the same day after the carotid stenting procedure. Immediate and short-term outcomes are reported. Results — A total of 98 ambulatory carotid stenting procedures (98 hemispheres in 92 patients) were performed. There were 66 men (72%), and the mean age was 70±9 years. Of the patients, 28% had neurological symptoms related to the treated artery within 3 months before the procedure. Sixteen percent of the patients had prior carotid endarterectomy, 4% had prior ipsilateral neck radiation, and 8% had complete occlusion of the contralateral internal carotid artery. Successful access site hemostasis was ensured in all patients with suture-mediated vascular closure devices in 96 (98%) and manual compression in 2. Clinical follow-up was available for 96% of the patients at a mean time of 6±4 months. There were no neurological events, deaths, repeated procedures, or major access site complications. Conclusions — Ambulatory carotid stenting is both safe and feasible. This approach will enhance the applicability of the procedure by increasing patient comfort and potentially reducing procedural costs.

Background —Carotid stenting is a less invasive percutaneous procedure than carotid endarterectomy for the treatment of carotid stenosis. Reports suggest that it can be performed with periprocedural complication rates similar to those of carotid endarterectomy. The purpose of this study was to determine short- and long-term outcomes in the largest prospective cohort of carotid stenting patients. Methods and Results —This study followed 528 consecutive patients (604 hemispheres/arteries) undergoing carotid stenting. There was a 0.6% (n=3) fatal stroke rate and 1% (n=5) nonstroke death rate at 30 days. The major stroke rate was 1% (n=6), and the minor stroke rate was 4.8% (n=29). The overall 30-day stroke and death rate was 7.4% (n=43). Over the 5-year study period, the 30-day minor stroke rate improved from 7.1% (n=7) for the first year to 3.1% (n=5) for the fifth year ( P Conclusions —Experience from a single group of operators demonstrates that carotid stenting can be performed with an acceptable 30-day complication rate. Late follow-up also demonstrates a low rate of fatal and nonfatal stroke. These results suggest that carotid stenting may be comparable to carotid endarterectomy, and it underscores the clinical equipoise and premise for the National Institute of Health–supported, randomized Carotid Revascularization Endarterectomy Versus Stent Trial comparing carotid stenting with carotid endarterectomy.

P202 Background: Ambulatory procedures have been shown to increase patient’s comfort and cost-efficacy. We sought to determine the feasibility of ambulatory carotid stenting in a series of patients undergoing the procedure. Methods: Patients were electively admitted and discharged the same-day if they had successful uncomplicated carotid stenting and had demonstrated complete vascular access site hemostasis following ambulation 4–6 hours after the procedure. Patients were followed for neurological events and vascular access site complications. Results: A total of 76 same-day carotid stenting procedures were performed on 73 patients (76 arteries). There were 53 (73 %) males and the mean age was 70 ± 8 years. Seventy-nine percent of the patients were asymptomatic on presentation. Fourteen patients (18 %) had prior ipsilateral CEA, 3 (4%) had prior ipsilateral neck radiation and 6 (8 %) had contralateral occlusions. Successful access site hemostasis was achieved in all patients, using suture-mediated vascular sealing devices in 75 cases (99%). In one case hemostasis was achieved manually after failure of the sealing device. Late follow-up currently available on 62 (98%) patients at a mean of 4 ± 3 months. There have been no neurological events, deaths, repeat procedures or significant access site complications. One patient developed serous discharge from the access site at 6 weeks without evidence of infection or hematoma and was managed conservatively without complications. Conclusion: Ambulatory carotid stenting is feasible and safe. This approach will foster the applicability of the procedure by increasing patient s comfort and potentially reducing procedural costs.