Print this pageUse Of Distal Embolic Protection During Renal Artery Angioplasty And Stenting
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Matthew S. Edwards, MD, Brandon L. Craven, B.S., Jeanette Stafford, M.S., Timothy E. Craven, M.S.P.H., Kenneth J. Sauve, B.S., Juan Ayerdi, M.D., Randolph L. Geary, M.D., George W. Plonk, Jr., M.D., Kimberley J. Hansen, M.D..
Wake Forest University School of Medicine, Winston-Salem, NC, USA.
BACKGROUND: Percutaneous renal artery angioplasty and/or stenting (RA-PTAS) is an increasingly utilized alternative to surgery for renal artery revascularization. Unfortunately, renal function responses following RA-PTAS appear to be inferior to those observed following surgical revascularization both in terms of improving and preventing deterioration of renal function post-intervention (short-term improvement in 20-30% v 45-60% and deterioration in 15-25% v 5-8% respectively in the aggregate literature). Atheroembolism during RA-PTAS has been postulated as a potential cause for these disparate results. Strategies to limit the occurrence of atheroembolism, such as the use of distal embolic protection (DEP) systems, may result in improved outcomes following RA-PTAS.
METHODS: All RA-PTAS procedures performed with DEP, using a commercially available temporary balloon occlusion and aspiration catheter, between October 2003 and July 2005 were reviewed. Glomerular filtration rate (eGFR) was estimated pre-intervention and 3-6 weeks post-intervention using the abbreviated Modification of Diet in Renal Disease formula. Renal function and hypertension response rates as well as procedural data were classified and reported according to American Heart Association Guidelines. Renal function improvement and deterioration were defined as a 20% increase and decrease in eGFR respectively compared to preoperative values. Continuous and categorical data were analyzed using t-test and chi-square methods.
RESULTS: 32 RA-PTAS procedures were performed with DEP in 16 females and 11 males with a mean age of 70 years. Mean pre-intervention degree of stenosis was 79%. Immediate technical success was achieved in 100% of cases. Mean pre and post-intervention serum creatinine, eGFR, and blood pressure were 1.85 v 1.57 mg/dl (P<0.001), 38.6 v 43.4 ml/min/1.73m2 (P<0.001), 176/81 v 158/76 mm Hg respectively (P=0.004 SBP, P=0.014 DBP). Renal function was improved in 16/32 procedures (50%) and worsened in none (0%).
CONCLUSIONS: RA-PTAS using DEP resulted in three to six week post-intervention renal function results approximating those of surgical revascularization. These data suggest that DEP use may prevent renal function harm during RA-PTAS as a result of atheroembolism and warrant further investigation.
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