Abstract
BACKGROUND - Preservation of renal function is an important objective of renal artery stent procedures. Although atheroembolization can cause renal dysfunction during renal stent procedures, whether adjunctive use of embolic protection devices or glycoprotein IIb/IIIa inhibitors improves renal function is unknown. METHODS AND RESULTS - One hundred patients undergoing renal artery stenting at 7 centers were randomly assigned to an open-label embolic protection device, Angioguard, or double-blind use of a platelet glycoprotein IIb/IIIa inhibitor, abciximab, in a 2×2 factorial design. The main effects of treatments and their interaction were assessed on percentage change in Modification in Diet in Renal Disease-derived glomerular filtration rate from baseline to 1 month using centrally analyzed creatinine. Filter devices were analyzed for the presence of platelet-rich thrombus. With stenting alone, stenting and embolic protection, and stenting with abciximab alone, glomerular filtration rate declined (P<0.05), but with combination therapy, it did not decline and was superior to the other allocations in the 2×2 design (P<0.01). The main effects of treatment demonstrated no overall improvement in glomerular filtration rate; although abciximab was superior to placebo (0±27% versus -10±20%; P<0.05), embolic protection was not (-1±28% versus -10±20%; P=0.08). An interaction was observed between abciximab and embolic protection (P<0.05), favoring combination treatment. Abciximab reduced the occurrence of platelet-rich emboli in the filters from 42% to 7% (P<0.01). CONCLUSIONS - Renal artery stenting alone, stenting with embolic protection, and stenting with abciximab were associated with a decline in glomerular filtration rate. An unanticipated interaction between Angioguard and abciximab was seen, with combination therapy better than no treatment or either treatment alone.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2752-2760 |
| Number of pages | 9 |
| Journal | Circulation |
| Volume | 117 |
| Issue number | 21 |
| DOIs | |
| State | Published - May 1 2008 |
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Keywords
- Kidney
- Peripheral vascular disease
- Platelets
- Stenosis
- Stents
Cite this
Embolic protection and platelet inhibition during renal artery stenting. / Cooper, Christopher J.; Haller, Steven T.; Colyer, William; Steffes, Michael W; Burket, Mark W.; Thomas, William J.; Safian, Robert; Reddy, Bhagat; Brewster, Pamela; Ankenbrandt, Mary Ann; Virmani, Renu; Dippel, Eric; Rocha-Singh, Krishna; Murphy, Timothy P.; Kennedy, David J.; Shapiro, Joseph I.; D'Agostino, Ralph D.; Pencina, Michael J.; Khuder, Sadik.
In: Circulation, Vol. 117, No. 21, 01.05.2008, p. 2752-2760.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Embolic protection and platelet inhibition during renal artery stenting
AU - Cooper, Christopher J.
AU - Haller, Steven T.
AU - Colyer, William
AU - Steffes, Michael W
AU - Burket, Mark W.
AU - Thomas, William J.
AU - Safian, Robert
AU - Reddy, Bhagat
AU - Brewster, Pamela
AU - Ankenbrandt, Mary Ann
AU - Virmani, Renu
AU - Dippel, Eric
AU - Rocha-Singh, Krishna
AU - Murphy, Timothy P.
AU - Kennedy, David J.
AU - Shapiro, Joseph I.
AU - D'Agostino, Ralph D.
AU - Pencina, Michael J.
AU - Khuder, Sadik
PY - 2008/5/1
Y1 - 2008/5/1
N2 - BACKGROUND - Preservation of renal function is an important objective of renal artery stent procedures. Although atheroembolization can cause renal dysfunction during renal stent procedures, whether adjunctive use of embolic protection devices or glycoprotein IIb/IIIa inhibitors improves renal function is unknown. METHODS AND RESULTS - One hundred patients undergoing renal artery stenting at 7 centers were randomly assigned to an open-label embolic protection device, Angioguard, or double-blind use of a platelet glycoprotein IIb/IIIa inhibitor, abciximab, in a 2×2 factorial design. The main effects of treatments and their interaction were assessed on percentage change in Modification in Diet in Renal Disease-derived glomerular filtration rate from baseline to 1 month using centrally analyzed creatinine. Filter devices were analyzed for the presence of platelet-rich thrombus. With stenting alone, stenting and embolic protection, and stenting with abciximab alone, glomerular filtration rate declined (P<0.05), but with combination therapy, it did not decline and was superior to the other allocations in the 2×2 design (P<0.01). The main effects of treatment demonstrated no overall improvement in glomerular filtration rate; although abciximab was superior to placebo (0±27% versus -10±20%; P<0.05), embolic protection was not (-1±28% versus -10±20%; P=0.08). An interaction was observed between abciximab and embolic protection (P<0.05), favoring combination treatment. Abciximab reduced the occurrence of platelet-rich emboli in the filters from 42% to 7% (P<0.01). CONCLUSIONS - Renal artery stenting alone, stenting with embolic protection, and stenting with abciximab were associated with a decline in glomerular filtration rate. An unanticipated interaction between Angioguard and abciximab was seen, with combination therapy better than no treatment or either treatment alone.
AB - BACKGROUND - Preservation of renal function is an important objective of renal artery stent procedures. Although atheroembolization can cause renal dysfunction during renal stent procedures, whether adjunctive use of embolic protection devices or glycoprotein IIb/IIIa inhibitors improves renal function is unknown. METHODS AND RESULTS - One hundred patients undergoing renal artery stenting at 7 centers were randomly assigned to an open-label embolic protection device, Angioguard, or double-blind use of a platelet glycoprotein IIb/IIIa inhibitor, abciximab, in a 2×2 factorial design. The main effects of treatments and their interaction were assessed on percentage change in Modification in Diet in Renal Disease-derived glomerular filtration rate from baseline to 1 month using centrally analyzed creatinine. Filter devices were analyzed for the presence of platelet-rich thrombus. With stenting alone, stenting and embolic protection, and stenting with abciximab alone, glomerular filtration rate declined (P<0.05), but with combination therapy, it did not decline and was superior to the other allocations in the 2×2 design (P<0.01). The main effects of treatment demonstrated no overall improvement in glomerular filtration rate; although abciximab was superior to placebo (0±27% versus -10±20%; P<0.05), embolic protection was not (-1±28% versus -10±20%; P=0.08). An interaction was observed between abciximab and embolic protection (P<0.05), favoring combination treatment. Abciximab reduced the occurrence of platelet-rich emboli in the filters from 42% to 7% (P<0.01). CONCLUSIONS - Renal artery stenting alone, stenting with embolic protection, and stenting with abciximab were associated with a decline in glomerular filtration rate. An unanticipated interaction between Angioguard and abciximab was seen, with combination therapy better than no treatment or either treatment alone.
KW - Kidney
KW - Peripheral vascular disease
KW - Platelets
KW - Stenosis
KW - Stents
UR - http://www.scopus.com/inward/record.url?scp=44449158362&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=44449158362&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.107.730259
DO - 10.1161/CIRCULATIONAHA.107.730259
M3 - Article
VL - 117
SP - 2752
EP - 2760
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 21
ER -