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
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
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
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