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Distal Embolic Protection for Renal Arterial Interventions

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Abstract

Distal or embolic protection has intuitive appeal for its potential to prevent embolization of materials generated during interventional procedures. Distal protection devices (DPDs) have been most widely used in the coronary and carotid vascular beds, where they have demonstrated the ability to trap embolic materials and, in some cases, to reduce complications. Given the frequency of chronic kidney disease in patients with renal artery stenosis undergoing stent placement, it is reasonable to propose that these devices may play an important role in limiting distal embolization in the renal vasculature. Careful review of the literature reveals that atheroembolization does occur during renal arterial interventions, although it often goes undetected. Early experience with DPDs in the renal arteries in patients with suitable anatomy suggests retrieval of embolic materials in approximately 71% of cases and renal functional improvement/stabilization in 98% of cases. The combination of platelet inhibition and a DPD may provide even greater benefit. Given the critical importance of renal functional preservation, it follows that everything that can be done to prevent atheroembolism should be undertaken including the use of DPDs when anatomically feasible. The data available at this time support a beneficial role for these devices.

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Authors and Affiliations

  1. Department of Diagnostic Imaging, Division of Interventional Radiology, Brown University Medical School, Providence, RI, 02903, USA

    Gregory J. Dubel & Timothy P. Murphy

  2. RI Hospital, 593 Eddy Street, 3rd Floor Main Building, Providence, RI, 02903, USA

    Gregory J. Dubel

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  1. Gregory J. Dubel
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  2. Timothy P. Murphy
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Correspondence to Gregory J. Dubel.

Additional information

Dr. Murphy has support as follows: supported by grants HL071556-01 and HL077221 from the National Heart, Lung, & Blood Institute, and also received research grants from Boston Scientific, Guidant, Cordis, and Otsuka Pharmaceuticals.

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Dubel, G.J., Murphy, T.P. Distal Embolic Protection for Renal Arterial Interventions. Cardiovasc Intervent Radiol 31, 14–22 (2008). https://doi.org/10.1007/s00270-007-9211-6

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  • DOI: https://doi.org/10.1007/s00270-007-9211-6

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