Frequent embolization in peripheral angioplasty: detection with an embolism protection device (AngioGuard) and electron microscopy.
OBJECTIVE
To evaluate the deliverability and protection capabilities of an embolism protection filter in angioplasty of peripheral arteries.


METHODS
The Angioguard emboli capture guidewire system was applied in 11 patients with femoropopliteal lesions (6 stenoses, 3 occlusions, 2 controls). Data on lesion crossing, flow deceleration and macroembolization were recorded. Filter membranes were evaluated with scanning electron microscopy (SEM).


RESULTS
System delivery was successful in all patients. Primary lesion crossing was feasible in four of six stenoses; predilatation was required in two of six. Marked flow deceleration was recorded in six patients. Emboli next to the filter were detected in each patient with concentric plaques, but could not reliably be removed with the filter. Downstream macroembolization was also present in all patients with concentric stenoses, but in none with chronic occlusion. None of the patients had clinical signs of ischemia. SEM analysis demonstrated only small particles on control group filters and non-obliterating fibrinous conglomerates on filters used in chronic occlusion. Substantial obliteration was seen on several filters used in stenotic lesions.


CONCLUSIONS
Microembolization of fibrin aggregates is a common incident in balloon angioplasty of femoropopliteal stenoses. Macroembolization occurred more frequently than previously reported. The use of embolism protection filters aided in the detection but not in the removal of larger emboli.
König
Claudius W
CW
Department of Diagnostic Radiology, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany. claudius.koenig@med.uni-tuebingen.de
Pusich
Benjamin
B
Tepe
Gunnar
G
Wendel
Hans-Peter
HP
Hahn
Ulrich
U
Schneider
Wilke
W
Claussen
Claus D
CD
Duda
Stephan H
SH
D000368:Aged; D000800:Angioplasty, Balloon; D004617:Embolism / Q000517:prevention & control*; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery; D005374:Filtration / Q000295:instrumentation*; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008855:Microscopy, Electron, Scanning; D011150:Popliteal Artery