Paul, Timir K.; Lee, John H.; White, Christopher J.
Abstract
Objectives: We sought to measure angiographic renal frame counts (RFC), as a quantitative angiographic assessment of renal blood flow, to evaluate microvascular compromise due to atheroembolism associated with RAS. Background: Atheroembolism associated with renal artery stenting (RAS) has been implicated as a cause for worsening renal function following successful intervention. Use of a distal embolic protection device (EPD) during RAS has been shown to be safe with debris capture in a high percentage of cases. However, objective benefit for renal function with EPD has been difficult to demonstrate. Methods: A control group of 30 consecutive patients (33 kidneys) who underwent RAS without EPD were compared with 33 consecutive patients (33 kidneys) who underwent RAS with EPD using RFC measurement. Results: The prestent and poststent mean RFC for the control group was 30.4 +/- 12.1 vs. 23.7 +/- 9.9 (P = 0.002) and for the EPD group it was 42.6 +/- 12.6 vs. 28.3 +/- 9.2 (P < 0.0001). The EPD group had a greater improvement in renal blood flow, manifested by a greater reduction of the RFC (D RFC) 14.2 +/- 15.2 vs. 6.7 +/- 11.7 (P = 0.03) compared with the control group. Conclusions: The use of an EPD was associated with a much larger improvement in renal blood flow (lower RFC) following RAS. This suggests that EPD's may be effective in preventing renal atheroembolic injury and that a controlled trial measuring the impact of EPD's on renal blood flow following RAS should be performed. (C) 2012 Wiley Periodicals, Inc.
