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KEY FACTS
Terminology
Preprocedure
Procedure
Outcomes
TERMINOLOGY
Synonyms
- Cerebral protection device
Definitions
- Embolic protection device (EPD): Intravascular device designed to prevent dislodged plaque/debris/embolic material from occluding distal vasculature
- Used with interventions in various vascular beds
- Internal carotid artery (ICA)/vertebral arteries
- Coronary arteries/saphenous vein grafts
- Renal arteries
- Upper/lower extremity arteries
- Venous interventions
- 3 categories based on mechanism of action
- Filter: Guidewire-mounted porous filtering device; deployed distal to target lesion
- Variable filter diameters permit optimal vessel apposition for capturing embolic debris
- Filter collapsed within delivery sheath while crossing target lesion
- Sheath retraction deploys filter within vessel
- After filter deployment, guidewire on which filter mounted becomes working guidewire
- Distal occlusion: Balloon occlusion, positioned distal to lesion
- Early form of embolic protection; now infrequently used for ICA interventions
- Balloon occlusion catheters still used for embolic protection in other vascular beds
- May be used with liquid embolic agents to prevent nontarget embolization
- Proximal flow blockage: Proximal occlusion of target artery using catheter-compatible sheath with occlusion balloon at distal end (a.k.a. circulatory control device)
- Balloon inflated in common carotid artery (CCA) proximal to lesion
- Additional smaller occlusion balloon placed via sheath into external carotid artery (ECA)
- Can actively aspirate sheath; create flow reversal to prevent ICA emboli
- 1 proprietary design permits active flow reversal; central lumen of sheath connected via external filter into common femoral vein; creates temporary arteriovenous fistula
- Central lumen of sheath also permits guidewire/catheter/stent introduction
- Filter: Guidewire-mounted porous filtering device; deployed distal to target lesion
- Used with interventions in various vascular beds
- Embolic protection device (EPD): Intravascular device designed to prevent dislodged plaque/debris/embolic material from occluding distal vasculature
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Procedure Steps
Alternative Procedures/Therapies
OUTCOMES
Complications
Expected Outcomes
Selected References
- Krishnan P et al: Comparison and analysis between the NAV6 embolic protection filter and SpiderFX EPD filter in superficial femoral artery lesions. J Interv Cardiol. 2021:9047596, 2021
- Costa F et al: Embolic protection devices in saphenous vein graft intervention. Circ Cardiovasc Interv. 12(5):e007879, 2019
- Wu WW et al: Anatomic eligibility for transcarotid artery revascularization and transfemoral carotid artery stenting. J Vasc Surg. 69(5):1452-60, 2019
- Kapadia SR et al: Protection against cerebral embolism during transcatheter aortic valve replacement. J Am Coll Cardiol. 69(4):367-77, 2017
- Kassavin DS et al: An update on the role of proximal occlusion devices in carotid artery stenting. J Vasc Surg. 65(1):271-5, 2017
- Kurzhals A et al: Efficiency test of current carotid embolic protection devices. Biomed Tech (Berl). 62(4):349-55, 2017
- Malas MB et al: Technical aspects of transcarotid artery revascularization using the ENROUTE transcarotid neuroprotection and stent system. J Vasc Surg. 65(3):916-20, 2017
- Omran J et al: Proximal balloon occlusion versus distal filter protection in carotid artery stenting: a meta-analysis and review of the literature. Catheter Cardiovasc Interv. 89(5):923-31, 2017
- Vos JA: Evidence overview: benefit of cerebral protection devices during carotid artery stenting. J Cardiovasc Surg (Torino). 58(2):170-7, 2017
- Giustino G et al: Neurological outcomes with embolic protection devices in patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis of randomized controlled trials. JACC Cardiovasc Interv. 9(20):2124-33, 2016
- Irani Z et al: The use of embolic protection device in lower extremity catheter-directed thrombolysis. Diagn Interv Imaging. 97(2):273-5, 2016
- Kwolek CJ et al: Results of the ROADSTER multicenter trial of transcarotid stenting with dynamic flow reversal. J Vasc Surg. 62(5):1227-34, 2015
- Lookstein RA et al: Distal embolic protection for infrainguinal interventions: how to and when? Tech Vasc Interv Radiol. 13(1):54-8, 2010
- Müller-Hülsbeck S et al: Embolic protection devices for peripheral application: wasteful or useful? J Endovasc Ther. 16 Suppl 1:I163-9, 2009
- Cooper CJ et al: Embolic protection and platelet inhibition during renal artery stenting. Circulation. 117(21):2752-60, 2008
- Divani AA et al: Microscopic and macroscopic evaluation of emboli captured during angioplasty and stent procedures in extracranial vertebral and internal carotid arteries. J Endovasc Ther. 15(3):263-9, 2008
- Henry M et al: Embolic protection for renal artery stenting. J Cardiovasc Surg (Torino). 49(5):571-89, 2008
- Misra S et al: Embolic protection devices in patients with renal artery stenosis with chronic renal insufficiency: a clinical study. J Vasc Interv Radiol. 19(11):1639-45, 2008
- Peterson BG: Embolic protection in infrainguinal interventions. Perspect Vasc Surg Endovasc Ther. 20(1):63-7, 2008
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References
Tables
Tables
KEY FACTS
Terminology
Preprocedure
Procedure
Outcomes
TERMINOLOGY
Synonyms
- Cerebral protection device
Definitions
- Embolic protection device (EPD): Intravascular device designed to prevent dislodged plaque/debris/embolic material from occluding distal vasculature
- Used with interventions in various vascular beds
- Internal carotid artery (ICA)/vertebral arteries
- Coronary arteries/saphenous vein grafts
- Renal arteries
- Upper/lower extremity arteries
- Venous interventions
- 3 categories based on mechanism of action
- Filter: Guidewire-mounted porous filtering device; deployed distal to target lesion
- Variable filter diameters permit optimal vessel apposition for capturing embolic debris
- Filter collapsed within delivery sheath while crossing target lesion
- Sheath retraction deploys filter within vessel
- After filter deployment, guidewire on which filter mounted becomes working guidewire
- Distal occlusion: Balloon occlusion, positioned distal to lesion
- Early form of embolic protection; now infrequently used for ICA interventions
- Balloon occlusion catheters still used for embolic protection in other vascular beds
- May be used with liquid embolic agents to prevent nontarget embolization
- Proximal flow blockage: Proximal occlusion of target artery using catheter-compatible sheath with occlusion balloon at distal end (a.k.a. circulatory control device)
- Balloon inflated in common carotid artery (CCA) proximal to lesion
- Additional smaller occlusion balloon placed via sheath into external carotid artery (ECA)
- Can actively aspirate sheath; create flow reversal to prevent ICA emboli
- 1 proprietary design permits active flow reversal; central lumen of sheath connected via external filter into common femoral vein; creates temporary arteriovenous fistula
- Central lumen of sheath also permits guidewire/catheter/stent introduction
- Filter: Guidewire-mounted porous filtering device; deployed distal to target lesion
- Used with interventions in various vascular beds
- Embolic protection device (EPD): Intravascular device designed to prevent dislodged plaque/debris/embolic material from occluding distal vasculature
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Procedure Steps
Alternative Procedures/Therapies
OUTCOMES
Complications
Expected Outcomes
Selected References
- Krishnan P et al: Comparison and analysis between the NAV6 embolic protection filter and SpiderFX EPD filter in superficial femoral artery lesions. J Interv Cardiol. 2021:9047596, 2021
- Costa F et al: Embolic protection devices in saphenous vein graft intervention. Circ Cardiovasc Interv. 12(5):e007879, 2019
- Wu WW et al: Anatomic eligibility for transcarotid artery revascularization and transfemoral carotid artery stenting. J Vasc Surg. 69(5):1452-60, 2019
- Kapadia SR et al: Protection against cerebral embolism during transcatheter aortic valve replacement. J Am Coll Cardiol. 69(4):367-77, 2017
- Kassavin DS et al: An update on the role of proximal occlusion devices in carotid artery stenting. J Vasc Surg. 65(1):271-5, 2017
- Kurzhals A et al: Efficiency test of current carotid embolic protection devices. Biomed Tech (Berl). 62(4):349-55, 2017
- Malas MB et al: Technical aspects of transcarotid artery revascularization using the ENROUTE transcarotid neuroprotection and stent system. J Vasc Surg. 65(3):916-20, 2017
- Omran J et al: Proximal balloon occlusion versus distal filter protection in carotid artery stenting: a meta-analysis and review of the literature. Catheter Cardiovasc Interv. 89(5):923-31, 2017
- Vos JA: Evidence overview: benefit of cerebral protection devices during carotid artery stenting. J Cardiovasc Surg (Torino). 58(2):170-7, 2017
- Giustino G et al: Neurological outcomes with embolic protection devices in patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis of randomized controlled trials. JACC Cardiovasc Interv. 9(20):2124-33, 2016
- Irani Z et al: The use of embolic protection device in lower extremity catheter-directed thrombolysis. Diagn Interv Imaging. 97(2):273-5, 2016
- Kwolek CJ et al: Results of the ROADSTER multicenter trial of transcarotid stenting with dynamic flow reversal. J Vasc Surg. 62(5):1227-34, 2015
- Lookstein RA et al: Distal embolic protection for infrainguinal interventions: how to and when? Tech Vasc Interv Radiol. 13(1):54-8, 2010
- Müller-Hülsbeck S et al: Embolic protection devices for peripheral application: wasteful or useful? J Endovasc Ther. 16 Suppl 1:I163-9, 2009
- Cooper CJ et al: Embolic protection and platelet inhibition during renal artery stenting. Circulation. 117(21):2752-60, 2008
- Divani AA et al: Microscopic and macroscopic evaluation of emboli captured during angioplasty and stent procedures in extracranial vertebral and internal carotid arteries. J Endovasc Ther. 15(3):263-9, 2008
- Henry M et al: Embolic protection for renal artery stenting. J Cardiovasc Surg (Torino). 49(5):571-89, 2008
- Misra S et al: Embolic protection devices in patients with renal artery stenosis with chronic renal insufficiency: a clinical study. J Vasc Interv Radiol. 19(11):1639-45, 2008
- Peterson BG: Embolic protection in infrainguinal interventions. Perspect Vasc Surg Endovasc Ther. 20(1):63-7, 2008
