title: Embolic protection and platelet inhibition during renal artery stenting.
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.
  
  
  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 2x2 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 2x2 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.
authors.affiliation: Cardiovascular Division, University of Toledo, 3000 Arlington Ave, MS 1036, Toledo, OH 43614, USA. Christopher.cooper@utoledo.edu
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Cooper
authors.forename: Steven T
authors.initials: ST
authors.lastname: Haller
authors.forename: William
authors.initials: W
authors.lastname: Colyer
authors.forename: Michael
authors.initials: M
authors.lastname: Steffes
authors.forename: Mark W
authors.initials: MW
authors.lastname: Burket
authors.forename: William J
authors.initials: WJ
authors.lastname: Thomas
authors.forename: Robert
authors.initials: R
authors.lastname: Safian
authors.forename: Bhagat
authors.initials: B
authors.lastname: Reddy
authors.forename: Pamela
authors.initials: P
authors.lastname: Brewster
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Ankenbrandt
authors.forename: Renu
authors.initials: R
authors.lastname: Virmani
authors.forename: Eric
authors.initials: E
authors.lastname: Dippel
authors.forename: Krishna
authors.initials: K
authors.lastname: Rocha-Singh
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Murphy
authors.forename: David J
authors.initials: DJ
authors.lastname: Kennedy
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Shapiro
authors.forename: Ralph D
authors.initials: RD
authors.lastname: D'Agostino
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.forename: Sadik
authors.initials: S
authors.lastname: Khuder
mesh_terms: D000077284:Abciximab; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D001794:Blood Pressure; D003131:Combined Modality Therapy; D004617:Embolism / Q000188:drug therapy / Q000517:prevention & control*; D005260:Female; D005919:Glomerular Filtration Rate; D006470:Hemorrhage; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D007431:Intraoperative Complications / Q000517:prevention & control; D007674:Kidney Diseases / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012077:Renal Artery / Q000601:surgery; D012078:Renal Artery Obstruction / Q000601:surgery*; D015607:Stents; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab