Edwards Matthew S, Corriere Matthew A, Craven Timothy E, Pan Xian Mang, Rapp Joseph H, Pearce Jeffrey D, Mertaugh Nicholas B, Hansen Kimberley J
Division of Surgical Sciences, Section on Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
J Vasc Surg. 2007 Jul;46(1):55-61. doi: 10.1016/j.jvs.2007.03.039.
Atheroembolization during renal artery angioplasty and stenting (RA-PTAS) has been postulated as a cause for the inferior renal function results observed when compared with those with surgical revascularization. To further characterize procedure-associated atheroembolism, we analyzed recovered atheroembolic debris and clinical data from patients undergoing RA-PTAS with distal embolic protection (DEP).
RA-PTAS procedures were performed with DEP using a commercially available temporary balloon occlusion and aspiration catheter system between July 2005 and December 2006. Following RA-PTAS but prior to deflation of the distal occlusion balloon, the static column of blood proximal to the balloon was aspirated and submitted for embolic particle analysis. Angiograms, demographics, and laboratory data were reviewed. Glomerular filtration rate (eGFR) was estimated before RA-PTAS and at 4 to 8 weeks postintervention using the abbreviated Modification of Diet in Renal Disease formula. Associations between clinical factors, captured particle counts, and changes in renal function were examined using univariate techniques and multiple linear regression.
Twenty-eight RA-PTAS procedures were performed with DEP. Mean total number of embolic particles counted per procedure was 2033 +/- 1553 for particles 20-60 microm and 265 +/- 132 for particles >60 microm. Significant positive associations with quantity of captured particles 20 to 60 microm were observed for African American race (P = .002), predilation (P = .005), and stent diameter (P < .001); a significant negative association was observed for preoperative aspirin use (P =.016). Quantity of captured particles >60 microm was positively associated with ratio of stent to renal artery diameter (P =.009). Change in eGFR was positively associated with preoperative aspirin use (P = .006) and preoperative eGFR (P < .001), while a negative association was observed for captured particle counts >60 microm (P = .015).
These results demonstrate the liberation of thousands of atheroembolic particles during RA-PTAS. Clinical, anatomic, and device-related factors may be predictive of procedural embolization, and increasing captured particle counts >60 microm were associated with inferior renal function results. Further investigation is warranted to establish relationships between atheroembolism, end organ functional impairment, and clinical responses.
肾动脉血管成形术和支架置入术（RA-PTAS）期间的动脉粥样硬化栓塞被认为是与外科血管重建术相比肾功能结果较差的一个原因。为了进一步描述与手术相关的动脉粥样硬化栓塞，我们分析了接受远端栓塞保护（DEP）的RA-PTAS患者回收的动脉粥样硬化栓塞碎片和临床数据。
在2005年7月至2006年12月期间，使用市售的临时球囊闭塞和抽吸导管系统，采用DEP进行RA-PTAS手术。在RA-PTAS之后但在远端闭塞球囊放气之前，抽吸球囊近端的静态血柱并进行栓塞颗粒分析。回顾血管造影、人口统计学和实验室数据。使用简化的肾脏疾病饮食改良公式在RA-PTAS之前和干预后4至8周估计肾小球滤过率（eGFR）。使用单变量技术和多元线性回归检查临床因素、捕获颗粒计数和肾功能变化之间的关联。
采用DEP进行了28例RA-PTAS手术。每个手术计数的栓塞颗粒平均总数为：20至60微米的颗粒为2033±1553个，大于60微米的颗粒为265±132个。观察到非裔美国人种族（P = .002）、预扩张（P = .005）和支架直径（P < .001）与捕获的20至60微米颗粒数量呈显著正相关；术前使用阿司匹林与捕获颗粒数量呈显著负相关（P = .016）。捕获的大于60微米的颗粒数量与支架与肾动脉直径的比值呈正相关（P = .009）。eGFR的变化与术前使用阿司匹林（P = .006）和术前eGFR（P < .001）呈正相关，而与捕获的大于60微米的颗粒计数呈负相关（P = .015）。
这些结果表明在RA-PTAS期间有成千上万的动脉粥样硬化栓塞颗粒释放。临床、解剖和与器械相关的因素可能预测手术栓塞，并且捕获的大于60微米的颗粒计数增加与较差的肾功能结果相关。有必要进一步研究以确定动脉粥样硬化栓塞、终末器官功能损害和临床反应之间的关系。
