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Embolic protection and platelet inhibition during renal artery stenting.
- Source :
-
Circulation [Circulation] 2008 May 27; Vol. 117 (21), pp. 2752-60. Date of Electronic Publication: 2008 May 19. - Publication Year :
- 2008
-
Abstract
- Background: Preservation of renal function is an important objective of renal artery stent procedures. Although atheroembolization can cause renal dysfunction during renal stent procedures, whether adjunctive use of embolic protection devices or glycoprotein IIb/IIIa inhibitors improves renal function is unknown.<br />Methods and Results: One hundred patients undergoing renal artery stenting at 7 centers were randomly assigned to an open-label embolic protection device, Angioguard, or double-blind use of a platelet glycoprotein IIb/IIIa inhibitor, abciximab, in a 2x2 factorial design. The main effects of treatments and their interaction were assessed on percentage change in Modification in Diet in Renal Disease-derived glomerular filtration rate from baseline to 1 month using centrally analyzed creatinine. Filter devices were analyzed for the presence of platelet-rich thrombus. With stenting alone, stenting and embolic protection, and stenting with abciximab alone, glomerular filtration rate declined (P<0.05), but with combination therapy, it did not decline and was superior to the other allocations in the 2x2 design (P<0.01). The main effects of treatment demonstrated no overall improvement in glomerular filtration rate; although abciximab was superior to placebo (0+/-27% versus -10+/-20%; P<0.05), embolic protection was not (-1+/-28% versus -10+/-20%; P=0.08). An interaction was observed between abciximab and embolic protection (P<0.05), favoring combination treatment. Abciximab reduced the occurrence of platelet-rich emboli in the filters from 42% to 7% (P<0.01).<br />Conclusions: Renal artery stenting alone, stenting with embolic protection, and stenting with abciximab were associated with a decline in glomerular filtration rate. An unanticipated interaction between Angioguard and abciximab was seen, with combination therapy better than no treatment or either treatment alone.
- Subjects :
- Abciximab
Aged
Aged, 80 and over
Angioplasty
Blood Pressure
Combined Modality Therapy
Embolism drug therapy
Female
Glomerular Filtration Rate
Hemorrhage
Humans
Intraoperative Complications prevention & control
Male
Middle Aged
Prostheses and Implants
Renal Artery surgery
Treatment Outcome
Antibodies, Monoclonal administration & dosage
Embolism prevention & control
Immunoglobulin Fab Fragments administration & dosage
Kidney Diseases prevention & control
Platelet Aggregation Inhibitors administration & dosage
Prosthesis Implantation
Renal Artery Obstruction surgery
Stents
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4539
- Volume :
- 117
- Issue :
- 21
- Database :
- MEDLINE
- Journal :
- Circulation
- Publication Type :
- Academic Journal
- Accession number :
- 18490527
- Full Text :
- https://doi.org/10.1161/CIRCULATIONAHA.107.730259