Complete versus partial distal embolic protection during renal artery stenting.
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 = 21). [corrected] 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).


CONCLUSIONS
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.
Kanjwal
Khalil
K
Cardiovascular Division, University of Toledo, Toledo, Ohio 43614, USA.
Haller
Steven
S
Steffes
Michael
M
Virmani
Renu
R
Shapiro
Joseph I
JI
Burket
Mark W
MW
Cooper
Christopher J
CJ
Colyer
William R
WR
D000077284:Abciximab; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000295:instrumentation*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D004617:Embolism / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012078:Renal Artery Obstruction / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D051437:Renal Insufficiency / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D003404:Creatinine; D000077284:Abciximab