CardioVascular and Interventional Radiology

, Volume 26, Issue 4, pp 334–339 | Cite as

Frequent Embolization in Peripheral Angioplasty: Detection with an Embolism Protection Device (AngioGuard) and Electron Microscopy

  • Claudius W. König
  • Benjamin Pusich
  • Gunnar Tepe
  • Hans-Peter Wendel
  • Ulrich Hahn
  • Wilke Schneider
  • Claus D. Claussen
  • Stephan H. Duda
Clinical Investigations


Purpose: 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. Conclusion: 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.


Angioplasty, peripheral vessels Embolization Embolization protection 



We thank Cordis (Haan, Germany; a Johnson & Johnson Company, Warren, NJ, USA) for providing the AngioGuard devices. We are grateful to Michael Bretzke for assistance with the study.

Presented at CIRSE annual meeting, September 22–26, 2001, Gothenburg, Sweden.


  1. 1.
    Théron, JG, Payelle, GG, Coskun, O, Huet, HF, Guimaraens, L 1996Carotid artery stenosis: Treatment with protected balloon angioplasty and stent placement.Radiology201627636PubMedGoogle Scholar
  2. 2.
    Müller-Hülsbeck, S. 2002Cerebral protection devices for treatment of carotid stenoses: Where do we stand today?Fortschr Röntgenstr174945954Google Scholar
  3. 3.
    Reimers, B, Corvaja, N, Moshiri, S, Saccà, S, Albiero, R, Di Mario, C, Pascotto, P, Colombo, A 2001Cerebral protection with filter devices during carotid artery stenting.Circulation1041215PubMedGoogle Scholar
  4. 4.
    Ohki, T, Roubin, GS, Veith, FJ, Iyer, SS, Brady, E 1999Efficacy of a filter device in the prevention of embolic events during carotid angioplasty and stenting.J Vasc Surg3010341044PubMedGoogle Scholar
  5. 5.
    Higginson, A, Alaeddin, F, Fishwick, G, Bolia, A 2001“Push and park”: An alternative strategy for management of embolic complication during balloon angioplasty.Eur J Vasc Endovasc Surg21279282CrossRefPubMedGoogle Scholar
  6. 6.
    McDermott, JC, Crummy, AB 1994Complications of angioplasty.Semin Interv Radiol11145149Google Scholar
  7. 7.
    Becker, GJ, Katzen, BT, Dake, MD 1989Noncoronary angioplasty.Radiology170921940PubMedGoogle Scholar
  8. 8.
    Stary, HC, Chandler, AB, Dinsmore, RE, Fuster, V, Glagov, S, Insull Jr, W, Rosenfeld, ME, Schwartz, CJ, Wagner, WD, Wissler, RW 1995A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis.Circulation9213551374PubMedGoogle Scholar
  9. 9.
    Sharma, PVP, Babu, SC, Shah, PM, Nassoura, ZE 1996Changing patterns of atheroembolism.Cardiovasc Surg4573579CrossRefPubMedGoogle Scholar
  10. 10.
    McCleary, AJ, Nelson, M, Dearden, NM, Calvey, TAJ, Gough, MJ 1998Cerebral haemodynamics and embolization during carotid angioplasty in high-risk patients.Br J Surg85771774CrossRefPubMedGoogle Scholar
  11. 11.
    Jordan, WD, Voellinger, DC, Doblar, DD, Plyushcheva, NP, Fisher, WS, McDowell, HA 1999Microemboli detected by transcranial Doppler monitoring in patients during carotid angioplasty versus carotid endarterectomy.Cardiovasc Surg73338CrossRefPubMedGoogle Scholar
  12. 12.
    Abraham, P, L’hoste, P, Pasco-Papon, A, Saumet, JL 1996Asymptomatic peripheral embolism during balloon angioplasty.AJR Am J Roentgenol16612301231Google Scholar
  13. 13.
    Zanella, FE, Berkefeld, J 2000Protected carotid stenting.Z Kardiol894752Google Scholar
  14. 14.
    Martin, JB, Pache, JC, Treggiari-Venzi, M, Murphy, KJ, Gailloud, P, Puget, E, Pizzolato, G, Sugiu, K, Guimaraens, L, Théron, J, Rüfenacht, DA 2001Role of distal balloon protection technique in the prevention of cerebral embolic events during carotid stent placement.Stroke32479484PubMedGoogle Scholar
  15. 15.
    Ohki, T, Marin, ML, Lyon, RT, Berdejo, GL, Soundararajan, K, Ohki, M, Yuan, JG, Faries, PL, Wain, RA, Sanchez, LA, Suggs, WD, Veith, FJ 1998Ex vivo human carotid bifurcation stenting: Correlation of lesion characteristics with embolic potential.J Vasc Surg27463471PubMedGoogle Scholar
  16. 16.
    Manninen, HI, Räsänen, HAT, Vanninen, RL, Vainio, P, Hippeläinen, M, Kosma, VM 1999Stent placement versus percutaneous transluminal angioplasty of human carotid arteries in cadavers in situ: Distal embolization and findings at intravascular US, MR imaging, and histopathologic analysis.Radiology212483492PubMedGoogle Scholar
  17. 17.
    Al-Hamali, S, Baskerville, P, Fraser, S, Walters, H, Markus, HS 1999Detection of distal emboli in patients with peripheral arterial stenosis before and after iliac angioplasty.J Vasc Surg29345351PubMedGoogle Scholar
  18. 18.
    Tepe, G, Hahn, U, Pusich, B, König, C, Müller-Schimpfle, M, Raygrotzki, S, Claussen, CD, Duda, SH 2001New strategies in platelet inhibition in noncoronary interventions.Semin Vasc Surg14143149CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 2003

Authors and Affiliations

  • Claudius W. König
    • 1
  • Benjamin Pusich
    • 1
  • Gunnar Tepe
    • 1
  • Hans-Peter Wendel
    • 2
  • Ulrich Hahn
    • 1
  • Wilke Schneider
    • 2
  • Claus D. Claussen
    • 1
  • Stephan H. Duda
    • 1
  1. 1.Department of Diagnostic RadiologyUniversity of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 TuebingenGermany
  2. 2.Clinic for Thoracic and Cardiovascular SurgeryUniversity of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 TuebingenGermany

Personalised recommendations