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CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2020; 4(01): 16-20
DOI: 10.4103/AJIR.AJIR_20_19
Original Article

Incidence of Distal Embolization during Peripheral Intervention using the NAV-6 Embolic Protection System

Timothy C. Huber
Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon
,
Younes Jahangiri Noudeh
Dotter Institute of Interventional Radiology, Oregon Health and Science University, Departments of
,
John F. Angle
Interventional Radiology, University Of Virginia, Charlottesville, Virginia, USA
,
Daniel Sheeran
Interventional Radiology, University Of Virginia, Charlottesville, Virginia, USA
,
Megan Tracci
Vascular Surgery, University Of Virginia, Charlottesville, Virginia, USA
,
Luke Wilkins
Interventional Radiology, University Of Virginia, Charlottesville, Virginia, USA
› Author Affiliations Financial support and sponsorship Nil.
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Purpose: To compare the rates of embolic debris (ED) generation during lower extremity arterial interventions and evaluate the safety and efficacy of the using an embolic protection device (EPD). Methods: This was a single-center retrospective review of 111 patients (114 vessels) having undergone peripheral arterial intervention with the use of an EPD (Emboshield NAV-6 device). A database was created through review of the electronic health record and images in PACS. The presence of ED was determined through visual inspection after retrieval of the device or from filling defects identified during digital subtraction angiography with the device deployed. Descriptive statistics were used to report the demographic and clinical information. Relative frequencies of debris generation were determined for vessel type, trans-atlantic inter-society consensus (TASC) classification, and type of intervention. Differences in frequencies between groups weer evaluated with the Chi-square test, and associations were examined using the logistic regression analysis. Results: Of the 114 vessels treated, 16 (14%) demonstrated true distal embolization (DE) past the filter basket and 58 (51%) demonstrated generation of ED as determined by filling of the filter basket. This was significantly higher in patients undergoing atherectomy (70%) compared with those undergoing thrombolysis (38%) or angioplasty with or without stenting (29%) (P < 0.001). Of those patients undergoing atherectomy, laser atherectomy had the lowest rate of DE (26%) compared with either orbital (67%) or directional atherectomy (57%) (P < 0.05). In regression analysis, atherectomy was the only factor with significant association with detection of ED (odds ratio: 4.52, P < 0.0001). There was no statistically significant difference in the frequency of debris generated based on vessel type or TASC classification. Conclusion: The frequency of ED is higher in patients undergoing atherectomy versus patients undergoing lysis or percutaneous transluminal balloon angioplasty with or without stenting. Laser atherectomy has a lower frequency of debris generation when compared to either orbital or directional atherectomy.

Arterial - atherectomy - distal embolization - peripheral arterial disease (PAD) - peripheral


Publication History

Received: 12 August 2019
Received: 15 September 2019

Accepted: 24 October 2019

Article published online:
16 March 2021

© 2019. The Arab Journal of Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Shammas NW, Dippel EJ, Coiner D, Shammas GA, Jerin M, Kumar A. Preventing Lower Extremity Distal Embolization Using Embolic Filter Protection: Results of the PROTECT Registry. J Endovasc Ther 2008;15:270–6.
  • 2 Shrikhande GV, Khan SZ, Hussain HG, Dayal R, McKinsey JF, Morrissey N. Lesion types and device characteristics that predict distal embolization during percutaneous lower extremity interventions. J Vasc Surg 2011;53:347-52.
  • 3 Wholey M. The role of embolic protection in peripheral arterial atherectomy. Tech Vasc Interv Radiol 2011;14:65-74.
  • 4 Bornak A, Milner R. Current debate on the role of embolic protection devices. Vasc Endovascular Surg 2012;46:441-6.
  • 5 Bartorelli AL, Koh TH, Di Pede F, Reimers B, Thuesen L, Amann FW, et al. Distal embolic protection during percutaneous coronary intervention in patients with acute coronary syndromes: The RUBY study. Acute Card Care 2006;8:148-54.
  • 6 Holden A, Hill A, Jaff MR, Pilmore H. Renal artery stent revascularization with embolic protection in patients with ischemic nephropathy. Kidney Int 2006;70:948-55.
  • 7 Kastrup A, Nägele T, Gröschel K, Schmidt F, Vogler E, Schulz J, et al. Incidence of new brain lesions after carotid stenting with and without cerebral protection. Stroke 2006;37:2312-6.
  • 8 Karnabatidis D, Katsanos K, Kagadis GC, Ravazoula P, Diamantopoulos A, Nikiforidis GC, et al. Distal embolism during percutaneous revascularization of infra-aortic arterial occlusive disease: An underestimated phenomenon. J Endovasc Ther 2006;13:269-80.
  • 9 Allie DE. To PROTECT or not to PROTECT? In lower extremity angioplasty procedures, “Why not?” is the question! J Endovasc Ther 2008;15:277-82.
  • 10 Hadidi OF, Mohammad A, Zankar A, Brilakis ES, Banerjee S. Embolic capture angioplasty in peripheral artery interventions. J Endovasc Ther 2012;19:611-6.
  • 11 Lookstein RA, Lewis S. Distal embolic protection for infrainguinal interventions: How to and when? Tech Vasc Interv Radiol 2010;13:54-8.
  • 12 Shammas NW, Dippel EJ, Coiner D, Shammas GA, Jerin M, Kumar A. Preventing lower extremity distal embolization using embolic filter protection: Results of the PROTECT registry. J Endovasc Ther 2008;15:270-6.
  • 13 Roberts D, Niazi K, Miller W, Krishnan P, Gammon R, Schreiber T, et al. Effective endovascular treatment of calcified femoropopliteal disease with directional atherectomy and distal embolic protection: Final results of the DEFINITIVE Ca++ trial. Catheter Cardiovasc Interv 2014;84:236-44.
  • 14 Tang GL, Chang DS, Sarkar R, Wang R, Messina LM. The effect of gradual or acute arterial occlusion on skeletal muscle blood flow, arteriogenesis, and inflammation in rat hindlimb ischemia. J Vasc Surg 2005;41:312-20.
  • 15 Shammas NW, Shammas GA, Dippel EJ, Jerin M, Shammas WJ. Predictors of distal embolization in peripheral percutaneous interventions: A report from a large peripheral vascular registry. J Invasive Cardiol 2009;21:628-31.