Semin intervent Radiol 2008; 25(1): 027-036
DOI: 10.1055/s-2008-1052303
© Thieme Medical Publishers

Expanding Use of Embolic Protection Devices

Martin G. Radvany1 , 3 , Michael Wholey2
  • 1Department of Radiology, Brooke Army Medical Center, Fort Sam Houston, Texas
  • 2Department of Radiology, University of Texas at San Antonio, San Antonio, Texas
  • 3Uniformed Services University of the Health Sciences, Bethesda, Maryland
Further Information

Publication History

Publication Date:
19 March 2008 (online)

ABSTRACT

Embolic protection devices were initially developed for the treatment of saphenous vein aorto-coronary bypass graft stenosis due to the significant risk of atheroembolism, and their use is well accepted. The use of these devices for carotid arterial interventions is also well accepted due to the significant consequences of embolization in the cerebral circulation. The use of these devices is extending to other vascular beds to include the renal arteries and lower extremities. We review the basic principles of these devices and their uses in various vascular beds based on our own experience as well as that in the literature.

REFERENCES

  • 1 Topol E J, Yadav J S. Recognition of the importance of embolization in atherosclerotic vascular disease.  Circulation. 2000;  101 570-580
  • 2 Baim D S, Wahr D, George B et al.. Randomized trial of a distal embolic protection device during percutaneous intervention of saphenous vein aorto-coronary bypass grafts.  Circulation. 2002;  105 1285-1290
  • 3 Stone G W, Rogers C, Hermiller J et al.. Randomized comparison of distal protection with a filter-based catheter and a balloon occlusion and aspiration system during percutaneous intervention of diseased saphenous vein aorto-coronary bypass grafts.  Circulation. 2003;  108 548-553
  • 4 Jordan Jr W D, Voellinger D C, Doblar D D et al.. Microemboli detected by transcranial Doppler monitoring in patients during carotid angioplasty versus carotid endarterectomy.  Cardiovasc Surg. 1999;  7 33-38
  • 5 Gray W A, Hopkins L N, Yadav S et al.. Protected carotid stenting in high-surgical-risk patients: the ARCHeR results.  J Vasc Surg. 2006;  44 258-268
  • 6 Yadav J S, Wholey M H, Kuntz R E et al.. Protected carotid-artery stenting versus endarterectomy in high-risk patients.  N Engl J Med. 2004;  351 1493-1501
  • 7 Naylor A R, Bolia A, Abbott R J et al.. Randomized study of carotid angioplasty and stenting versus carotid endarterectomy: a stopped trial.  J Vasc Surg. 1998;  28 326-334
  • 8 Theron J G, Payelle G G, Coskun O et al.. Carotid artery stenosis: treatment with protected balloon angioplasty and stent placement.  Radiology. 1996;  201 627-636
  • 9 Lin P H, Bush R L, Conklin B S et al.. Late complications of aortoiliac stent placement-atheroembolization of the lower extremities.  J Surg Res. 2002;  103 153-159
  • 10 Uher P, Nyman U, Lindh M et al.. Long-term results of stenting for chronic arterial occlusion.  J Endovasc Ther. 2002;  9 67-75
  • 11 Matchett W J, McFarland D R, Eidt J F, Moursi M M. Blue toe syndrome: treatment with intra-arterial stents and review of therapies.  J Vasc Interv Radiol. 2000;  11 585-592
  • 12 Rickard M J, Fisher C M, Soong C V et al.. Limitations of intra-arterial thrombolysis.  Cardiovasc Surg. 1997;  5 634-640
  • 13 Chalmers R T, Hoballah J J, Kresowik T F et al.. Late results of a prospective study of direct intraarterial urokinase infusion for peripheral arterial and bypass graft occlusions.  Cardiovasc Surg. 1995;  3 293-297
  • 14 Suri R, Wholey M H, Postoak D et al.. Distal embolic protection during femoropopliteal atherectomy.  Catheter Cardiovasc Interv. 2006;  67 417-422
  • 15 Wholey M H, Maynar M A, Wholey M H et al.. Comparison of thrombolytic therapy for lower-extremity acute, subacute and chronic arterial occlusions.  Cathet Cardiovasc Diagn. 1998;  44 159-169
  • 16 Kasirajan K, Haskal Z J, Ouriel K. The use of mechanical thrombectomy devices in the management of acute peripheral arterial occlusive disease.  J Vasc Interv Radiol. 2001;  12 405-411
  • 17 Siablis D, Karnabatidis D, Katsanos K et al.. Outflow protection filters during percutaneous recanalization of lower extremities' arterial occlusions: a pilot study.  Eur J Radiol. 2005;  55 243-249
  • 18 Mewissen M. Initial Experience in Distal Protection in Lower Extremity Interventions. Presented at: All That Jazz 2005 New Orleans, LA; April 2005
  • 19 Holden A, Hill A. Renal angioplasty and stenting with distal protection of the main renal artery in ischemic nephropathy: early experience.  J Vasc Surg. 2003;  38 962-968
  • 20 Hagspiel K D, Stone J R, Leung D A. Renal angioplasty and stent placement with distal protection: preliminary experience with the FilterWire EX.  J Vasc Interv Radiol. 2005;  16 125-131
  • 21 Henry M, Henry I, Klonaris C et al.. Renal angioplasty and stenting under protection: the way for the future?.  Catheter Cardiovasc Interv. 2003;  60 299-312
  • 22 Li S S, Wong C H, Lam C W. Renal angioplasty under protection of the PercuSurge GuardWire Plus System.  J Invasive Cardiol. 2003;  15 148-150
  • 23 Filippo F, Francesco M, Francesco R et al.. Percutaneous angioplasty and stenting of left subclavian artery lesions for the treatment of patients with concomitant vertebral and coronary subclavian steal syndrome.  Cardiovasc Intervent Radiol. 2006;  29 348-353
  • 24 Schenk W G. Subclavian steal syndrome from high-output brachiocephalic arteriovenous fistula: a previously undescribed complication of dialysis access.  J Vasc Surg. 2001;  33 883-885
  • 25 Duijm L E, Liem Y S, van der Rijt R H et al.. Inflow stenoses in dysfunctional hemodialysis access fistulae and grafts.  Am J Kidney Dis. 2006;  48 98-105
  • 26 Gimelli G, Tefera G, Turnipseed W D. Vertebral artery embolic protection via ipsilateral brachial approach during left subclavian artery angioplasty and stenting: a case report.  Vasc Endovascular Surg.. 2006;  40 235-238
  • 27 Bogousslavsky J, van Melle G, Regli F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke.  Stroke. 1988;  19 1083-1092
  • 28 Wityk R J, Chang H M, Rosengart A et al.. Proximal extracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry.  Arch Neurol. 1998;  55 470-478
  • 29 Hornig C R, Lammers C, Butter T et al.. Long-term prognosis of infratentorial transient ischemic attacks and minor strokes.  Stroke. 1992;  23 199-240
  • 30 Mohr J P, Thompson J L, Lazar R M et al.. A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke.  N Engl J Med. 2001;  345 1444-1451
  • 31 Henry M, Polydorou A, Henry I et al.. Angioplasty and stenting of extracranial vertebral artery stenosis.  Int Angiol. 2005;  24 311-324

Martin G RadvanyM.D. 

Department of Radiology, Johns Hopkins Hospital

600 N. Wolfe Street, Baltimore, MD 21287

Email: mradvan2@jhmi.edu