Embolic protection: Limitations of current technology and novel concepts

Abstract

Distal embolic event is one of the major limitations of coronary and non-coronary vascular interventions. Balloon and filter-based Embolic Protection Devices (EPDs) are a new class of interventional devices, used to prevent consequential morbidity and mortality of the distal embolic events. Data from first generation EPD supply proof of concept and show approximately 40% reduction in mortality and morbidity, when EPDs are used during saphenous vein grafts (SVGs) interventions. Current limitations of all first generation EPD technology taper their penetration. With breakthroughs in embolic protection technology, it is estimated that, in the near future, EPDs will be used with stenting in all high-risk lesions (SVGs, carotid arteries and acute coronary syndromes), become the standard of care and even be used in low risk cases.

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary

“…[245][246][247][248][249][250][251] If properly deployed, an EPD can reduce the neurological risks associated with CAS, but these devices may also be associated with failures. 53,196,198,247,[252][253][254][255][256][257][258] Among the general risks is access-site injury, which complicates 5% of cases, but most such injuries involve pain and hematoma formation and are self-limited. 259 -262 Contrastinduced nephropathy has been reported in Ͻ1% of cases, because CAS is generally avoided in patients with severe renal dysfunction.…”

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary

“…If properly deployed, an EPD can reduce the neurological risks associated with CAS, but these devices may also be associated with failures (53,196,198,247,(252)(253)(254)(255)(256)(257)(258).…”

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

“…[245][246][247][248][249][250][251] If properly deployed, an EPD can reduce the neurological risks associated with CAS, but these devices may also be associated with failures. 53,196,198,247,[252][253][254][255][256][257][258] Among the general risks is access-site injury, which complicates 5% of cases, but most such injuries involve pain and hematoma formation and are self-limited. [259][260][261][262] Contrast-induced nephropathy has been reported in <1% of cases, because CAS is generally avoided in patients with severe renal dysfunction.…”