Role Of Embolic Protection Devices Research Articles

Embolic Protection Devices are Not Associated with Improved Outcomes of Atherectomy for Lower Extremity Revascularization

Atherectomy is associated with a risk of distal embolization, but the role of embolic protection devices (EPDs) during atherectomy is not well-defined. This study examines the utilization and impact of EPD on the outcomes of atherectomy during peripheral vascular interventions (PVIs). The annual trend in utilization of EPD during atherectomy in the Vascular Quality Initiative PVI files (2010-2018) was derived. Patients with concomitant open surgery, acute limb ischemia, emergent-status, concomitant thrombolysis, missing indication, missing EPD use, and missing long-term follow-up data were excluded. The characteristics of patients undergoing atherectomy with and without EPD were compared. Propensity matching based on age, gender, race, chronic obstructive pulmonary disease, coronary artery disease, end-stage renal disease, prior PVI, indication, urgent-status, TransAtlantic interSociety Consensus classification, and anatomical location of lesion was performed. The perioperative and 1-year outcomes of the matched groups were compared. EPD was used in 23.3% of atherectomy procedures (n=5,013/21,500). The utilization of EPD with atherectomy increased from 8.8% to 22.7% (P=0.003) during the study period. Patients undergoing atherectomy without EPD were more likely to have ESRD (7.8% vs. 5.2%; P<0.001), tissue loss (31% vs. 23.1; P<0.001), tibial intervention (39.6% vs. 23.3%; P<0.001), higher number of arteries treated (1.78±0.92 vs. 1.68±0.93; P=0.001), and longer length of lesion (21.15±21.14 vs. 19±20.27cm; P=0.004). Conversely, patients undergoing atherectomy with EPD were more likely to be White (81.1% vs. 74%; P<0.001), have a history of smoking (80.6% vs. 74.5%; P<0.001), chronic obstructive pulmonary disease (24.8% vs. 21.6%; P<0.037), coronary artery disease (38.5% vs. 33.2%; P=0.002), prior percutaneous coronary intervention (24.3% vs. 19.9%, P=0.005), prior coronary artery bypass grafting (32.3% vs. 24.9%; P<0.001), and prior PVI (49.2% vs. 45.1%; P=0.023). After propensity matching, there were 1,007 patients in each group with no significant difference in baseline characteristics. There was no significant difference in short-term outcomes including the rate of distal embolization, technical success, dissection, perforation, discharge to home, and 30-day mortality. The use of EPD was, however, associated with longer fluoroscopy time. At 1-year, there was also no difference in primary patency, ipsilateral minor or major amputation, ankle brachial index improvement, reintervention, or mortality rate between patients who underwent atherectomy with and without EPD. EPD has been increasingly used in conjunction with atherectomy especially in patients with claudication and femoropopliteal disease. However, the use of EPD during atherectomy does not seem to impact the outcomes. Further research is needed to justify the additional cost and fluoroscopy time associated with the use of EPD during atherectomy.

Embolic Protection Devices Are Not Associated With Improved Outcomes of Atherectomy for Lower Extremity Revascularization

Atherectomy increases distal embolization, but the role of embolic protection devices (EPDs) during atherectomy is not well-defined. This study examines the utilization and impact of EPDs on the outcomes of atherectomy during peripheral vascular interventions (PVIs).

TCT CONNECT-366 Role of Embolic Protection Devices in Reducing Major Adverse Limb Events in Femoropopliteal Arterial Interventions in a Matched Cohort of Patients With Critical Limb Ischemia: Results From the XLPAD Registry

TCT CONNECT-366 Role of Embolic Protection Devices in Reducing Major Adverse Limb Events in Femoropopliteal Arterial Interventions in a Matched Cohort of Patients With Critical Limb Ischemia: Results From the XLPAD Registry

Silent cerebral injury after transcatheter aortic valve implantation and the preventive role of embolic protection devices: A systematic review and meta-analysis

BackgroundThe aims of this study were: 1) to evaluate silent cerebral injury detected by cerebral diffusion weighted magnetic resonance imaging (DW-MRI) after transcatheter aortic valve implantation (TAVI); and 2) to assess the efficacy of embolic protection devices (EPDs) on DW-MRI endpoints. MethodsWe included in a pooled analysis 25 prospective studies reporting post-procedural cerebral DW-MRI data after TAVI (n=1225). Among these studies, we included in a meta-analysis 6 studies investigating TAVI performed with versus without EPDs (n=384). Primary endpoints were the number of new lesions per patient and the total lesion volume, while secondary endpoints were the number of patients with new lesions and the single lesion volume. ResultsThe main pooled DW-MRI outcomes were: patients with new ischemic lesions, 77.5% (95% confidence interval=71.7–83.3%); total lesion volume, 437.5mm3 (286.7–588.3mm3); single lesion volume, 78.1mm3 (56.7–99.5mm3); and number of new lesions per patient, 4.2 (3.4–5.0). The use of EPDs was associated with a significant reduction in total lesion volume (mean difference [95% confidence interval]=−111.1mm3 [−203.6 to −18.6mm3]; p=0.02) and single lesion volume (−12.1mm3 [−18.3 to −6.0mm3]; p=0.0001) after TAVI. ConclusionsSilent cerebral injury occurs in the majority of patients undergoing TAVI and DW-MRI allows a precise characterization of new ischemic brain lesions. EPDs reduce the total and single volume of such lesions detected after the procedure, although the number of new lesions per patient and the number of patients with new lesions are not significantly reduced by such devices.

Current Debate on the Role of Embolic Protection Devices

The role of embolic protection devices (EPDs) during percutaneous arterial revascularization is still debated. This article discusses the use, the limitations, and issues of the variety of EPDs in different vascular beds, with a particular focus on the lower extremity arterial interventions.

Role of embolic protection devices in ostial saphenous vein graft lesions

Although embolic protection devices (EPDs) have been shown to be beneficial in saphenous vein graft (SVG) lesions, their role in the subgroup of ostial SVG lesions has received limited study. The coronary angiograms and procedural outcomes of 109 patients undergoing stenting of 113 ostial SVG lesions were retrospectively reviewed to determine the frequency of EPD use and the periprocedural outcomes. Ninety-eight (87%) of the 113 lesions were suitable for EPD use, that was used in 70 lesions (71%). A Filterwire (Boston Scientific) or a SPIDER (ev3) filter were used in 54 (77%) and 16 (23%) of lesions, respectively. Difficulty retrieving the filter post stenting was encountered in eight lesions (11%) and led to stent thrombosis causing cardiac arrest in one patient (1%). Angiographic success was achieved in 111 (98%) of 113 lesions. EPDs can be utilized in the majority of ostial SVG lesions, but in 11% of cases filter retrieval can be challenging and may rarely (in approximately 1%) lead to a significant complication.

The role of embolic protection devices during carotid stenting prior to cardiac surgery in asymptomatic patients: Empty filters?

The purpose of this study was to analyze the debris captured in the distal protection filters used during carotid artery stenting (CAS). CAS is an option available to high-risk patients requiring revascularization. Filters are suggested for optimal stroke prevention during CAS. From May 2005 to June 2007, filters from 59 asymptomatic patients who underwent CAS were collected and sent to a specialized laboratory for light-microscope and histological analysis. Peri- and postprocedural outcomes were assessed during 1-year follow-up. On the basis of biomedical imaging of the filter debris, the captured material could not be identified as embolized particles from the carotid plaque. On histological analysis the debris consisted mainly of red blood cell aggregates and/ or platelets, occasionally accompanied by granulocytes. We found no consistent histological evidence of embolized particles originating from atherosclerotic plaques. Post-procedure, three neurological events were reported: two (3.4%) transient ischemic attacks (TIA) and one (1.7%) ipsilateral minor stroke. The filters used during CAS in asymptomatic patients planned for cardiac surgery often remained empty. These findings may be explained by assuming that asymptomatic patients feature a different atherosclerotic plaque composition or stabilization through antiplatelet medication. Larger, randomized trials are clearly warranted, especially in the asymptomatic population.

TCT-590: Renal Angioplasty and Stenting. Limitations. Role of Embolic Protection Devices

TCT-590: Renal Angioplasty and Stenting. Limitations. Role of Embolic Protection Devices

Commentary on "The Role of Embolic Protection Devices in Renal Artery Stenting"

Commentary on "The Role of Embolic Protection Devices in Renal Artery Stenting"

The Role of Embolic Protection Devices in Renal Artery Stenting

Renal artery angioplasty and stenting is commonly performed for the treatment of hypertension and ischemic nephropathy. An increasing number of procedures are being undertaken for "renal preservation" despite an associated risk of renal function decline related to the embolization of atheromatous debris liberated during the procedure. Although smaller, more flexible guidewires and stents have been developed to decrease the amount of debris created, interest in the off-label use of embolic protection devices has increased. We review the available embolic protection devices and currently available data regarding their use in renal artery interventions. Although not designed for use in the renal artery, there are at least theoretical reasons to believe that embolic protection during renal artery angioplasty may improve outcomes.