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Catheter Cardiovasc Interv. 2012 Nov 15;80(6):1019-22. doi: 10.1002/ccd.24289. Epub 2012 Mar 9.

Renal embolic protection devices improve blood flow after stenting for atherosclerotic renal artery stenosis.

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1
Department of Cardiovascular Diseases, The John Ochsner Heart and Vascular Institute, Ochsner Medical Institutions, New Orleans, Louisiana, USA.

Abstract

OBJECTIVES:

We sought to measure angiographic renal frame counts (RFC), as a quantitative angiographic assessment of renal blood flow, to evaluate microvascular compromise due to atheroembolism associated with RAS.

BACKGROUND:

Atheroembolism associated with renal artery stenting (RAS) has been implicated as a cause for worsening renal function following successful intervention. Use of a distal embolic protection device (EPD) during RAS has been shown to be safe with debris capture in a high percentage of cases. However, objective benefit for renal function with EPD has been difficult to demonstrate.

METHODS:

A control group of 30 consecutive patients (33 kidneys) who underwent RAS without EPD were compared with 33 consecutive patients (33 kidneys) who underwent RAS with EPD using RFC measurement.

RESULTS:

The prestent and poststent mean RFC for the control group was 30.4 ± 12.1 vs. 23.7 ± 9.9 (P = 0.002) and for the EPD group it was 42.6 ± 12.6 vs. 28.3 ± 9.2 (P < 0.0001). The EPD group had a greater improvement in renal blood flow, manifested by a greater reduction of the RFC (Δ RFC) 14.2 ± 15.2 vs. 6.7 ± 11.7 (P = 0.03) compared with the control group.

CONCLUSIONS:

The use of an EPD was associated with a much larger improvement in renal blood flow (lower RFC) following RAS. This suggests that EPD's may be effective in preventing renal atheroembolic injury and that a controlled trial measuring the impact of EPD's on renal blood flow following RAS should be performed.

PMID:
22407515
DOI:
10.1002/ccd.24289
[Indexed for MEDLINE]
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