Complete versus partial distal embolic protection during renal artery stenting

Khalil Kanjwal, Steven Haller, Michael W Steffes, Renu Virmani, Joseph I. Shapiro, Mark W. Burket, Christopher J. Cooper, William R. Colyer

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective: The aim of this study was to evaluate whether complete embolic protection is superior to partial embolic protection for preservation of kidney function during renal artery angioplasty and stenting. Background: Renal artery angioplasty and stenting (RAAS) is a common treatment for atherosclerotic renal artery stenosis. However, RAAS may be complicated by peri-procedural loss of kidney function. Methods: In total, 44 patients were randomized to embolic protection devices (EPD) use; 25 complete and 19 partial embolic protection. These patients were further randomized to receive abciximab (n = 23) or placebo (n = 20). MDRD glomerular filtration rate (GFR), was used as the primary measure of renal function. Creatinine was measured by a modified Jaffe reaction using the IDMS-traceable assay. The primary endpoint was the percent change in estimated glomerular filtration rate (eGFR) 1 month following stent placement. Results: There was no difference in percent change eGFR at 1 month between complete or partial protection (-4 ± 25 vs. +3 ± 30, P = 0.45). Abciximab was associated with a net improvement in eGFR when compared with placebo (+0.5 ± 27 vs. -11 ± 20, P = 0.04). On subgroup analysis, the use of abciximab was associated with significantly improved eGFR in the partial distal embolic protection group (+14 ± 33 vs. -17 ± 13 %, P = 0.018) but not in the complete distal embolic protection group (+2.5 ± 26 vs. -11 ± 24, P = 0.42), however, there was no interaction between completeness of protection and abciximab on eGFR (P = ns). Capture of embolic material was more likely with complete protection when compared with those receiving partial protection (51% vs. 21%, P < 0.05). Conclusion: Complete protection was superior to partial protection for the capture of athermanous debris during renal artery stenting. However, this was not associated with improved renal function. Importantly, Abciximab conferred a benefit for renal function that was independent of the degree of embolic protection.

Original languageEnglish (US)
Pages (from-to)725-730
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Volume73
Issue number6
DOIs
StatePublished - May 1 2009

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Renal Artery
Glomerular Filtration Rate
Kidney
Angioplasty
Embolic Protection Devices
Placebos
Renal Artery Obstruction
Stents
Creatinine
abciximab

Keywords

  • Kidney
  • Peripheral vascular disease
  • Platelets
  • Stenosis
  • Stents

Cite this

Complete versus partial distal embolic protection during renal artery stenting. / Kanjwal, Khalil; Haller, Steven; Steffes, Michael W; Virmani, Renu; Shapiro, Joseph I.; Burket, Mark W.; Cooper, Christopher J.; Colyer, William R.

In: Catheterization and Cardiovascular Interventions, Vol. 73, No. 6, 01.05.2009, p. 725-730.

Research output: Contribution to journalArticle

Kanjwal, K, Haller, S, Steffes, MW, Virmani, R, Shapiro, JI, Burket, MW, Cooper, CJ & Colyer, WR 2009, 'Complete versus partial distal embolic protection during renal artery stenting', Catheterization and Cardiovascular Interventions, vol. 73, no. 6, pp. 725-730. https://doi.org/10.1002/ccd.21932
Kanjwal, Khalil ; Haller, Steven ; Steffes, Michael W ; Virmani, Renu ; Shapiro, Joseph I. ; Burket, Mark W. ; Cooper, Christopher J. ; Colyer, William R. / Complete versus partial distal embolic protection during renal artery stenting. In: Catheterization and Cardiovascular Interventions. 2009 ; Vol. 73, No. 6. pp. 725-730.
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AU - Kanjwal, Khalil

AU - Haller, Steven

AU - Steffes, Michael W

AU - Virmani, Renu

AU - Shapiro, Joseph I.

AU - Burket, Mark W.

AU - Cooper, Christopher J.

AU - Colyer, William R.

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