Preliminary study on selective usage of embolic protection device during SilverHawk atherectomy to prevent distal embolization

Abstract

Objective To explore the clinical effectiveness and safety of selective usage of embolic protection device to prevent distal embolization during SilverHawk atherectomy for atherosclerotic femoropopliteal artery disease. Methods From Jan 2014 to December 2015, 45 femoropopliteal artery atherosclerotic patients were treated with SilverHawk atherectomy and selective embolic protection device (EPD). The indication for EPD was instent restenosis, highly calcified lesion, suspicious of thrombosis, ulcerated lesion, and single below-the-knee runoff. All cases who met the indication were treated with atherectomy and EPD, and those who did not meet the indication were treated with or without EPD according to the patient's choice. The embolic related complications were analyzed. Results Twenty three out of 45 patients who met the EPD indication were all treated with SilverHawk atherectomy under EPD protection, filter captured debris in 17 patients (73.9%) of the patients. The other 22 patients who did not meet the indication were divided into 2 groups according to the patient's choice of EPD usage, 11 were treated by atherectomy with EPD and 11 without EPD. One case out of 11 unindicated patients without EPD suffered a tibioperoneal trunk embolization and restored with catheter aspiration. For 1/11 (9.1%) unindicated cases with EPD protection, the filter captured embolization. There was a significant difference of distal embolization rate between the indicated and unindicated patients (χ2=19.368, P=0.000). All filters were retrieved successfully without any distal embolization and any complications except arterial spasm occurred in 2 patients and restored well with nitroglycerin. Conclusions It is safe and effective for selective usage of embolic protection device to prevent distal embolization during SilverHawk atherectomy for atherosclerotic femoropopliteal artery disease. Key words: Atherectomy/AE; Embolism/CO/PC; Stents