title: Evaluating embolic reduction techniques concurrent to infrainguinal interventions: a single-center experience.
abstract: OBJECTIVE
  To report a single-center retrospective evaluation of embolic reduction strategies concurrent to infrainguinal atherectomy intervention.
  
  
  METHODS
  Fifty-five consecutive atherectomy patients from 2011 to 2012 treated with embolic reduction devices were analyzed. Embolic load was stratified by lesion type, atherectomy technique, debris capture effectiveness, and risk factor characteristics. Over 80% of lesions were complex. Baseline stenosis and average lesion length were 94.2 ± 6.4% and 172.8 ± 85.5 mm, respectively. Our embolic reduction strategy included a systematic approach using the Proteus device in all cases and then in combination with the SpiderFX for long or complex lesions. Debris was analyzed for count and aggregate surface area.
  
  
  RESULTS
  Procedural success was 98.2%, with no in-hospital serious adverse events. The mean aggregated surface area of captured debris was 22 ± 20 mm². Thrombolysis with laser produced the highest amount of embolic load followed by laser, directional, and orbital atherectomy procedures (P<.05). Patients with restenotic/in-stent restenotic lesions produced larger amounts of debris (P<.05). No embolizations were recorded up to discharge. Proteus accounted for two-thirds of the debris captured in our study; its capture efficiency increased as device and lesion length met. An inverse relation was also found between lesion length and embolic protection device capture efficacy (TASC-II B vs D; P<.02).
  
  
  CONCLUSIONS
  An embolic reduction strategy using the Proteus catheter alone, particularly when Proteus and lesion lengths meet, or with the SpiderFX in complex infrainguinal atherectomy procedures, can be an effective tool. Current findings suggest potential optimization of future "at risk" interventions.
authors.affiliation: Cardiology Associates of Northwest Indiana, P.C./10010 Donald S. Powers Drive, Munster, IN 46321 USA. prakashmakam@comcast.net.
authors.forename: Prakash
authors.initials: P
authors.lastname: Makam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D017073:Atherectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D004617:Embolism / Q000628:therapy*; D005260:Female; D006801:Humans; D007264:Inguinal Canal; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices