Campbell J E, Stone P A, Bates M C
Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine, Charleston Division, Charleston, WV, USA.
J Cardiovasc Surg (Torino). 2010 Oct;51(5):747-54.
The efficacy of embolic protection devices (EPDs) have been studied extensively in coronary saphenous vein grafts and extra cranial cerebrovascular disease. Recent ex-vivo and in-vivo renal artery stenting studies suggest atheroembolism is not unique to the coronary and cerebrovascular domain and it seems intuitive, renal EPDs may be beneficial. In an attempt to better understand the current objective evidence regarding renal protection efficacy we systematically reviewed the contemporary literature and summarize the findings herein. There is increasing observational data suggesting the use of embolic protection devices decrease the risk of continued decline in renal function after renal artery stenting. There is also prospective randomized data to suggest that the use of adjuvant IIb/IIIa glycoprotein inhibitor and embolic protection has synergistic benefit, but this is a very small series. However, there are currently no well controlled prospective trials to conclude the added risk and expense of renal protection is countered by proven clinical benefit. Based on the literature compiled in this manuscript we do believe EPDs should be considered in some high-risk patients.
栓塞保护装置（EPDs）在冠状动脉大隐静脉旁路移植术和颅外脑血管疾病中的疗效已得到广泛研究。最近的体外和体内肾动脉支架置入研究表明，动脉粥样硬化栓塞并非冠状动脉和脑血管领域所特有，似乎可以直观地认为，肾用EPDs可能有益。为了更好地了解目前关于肾脏保护疗效的客观证据，我们系统地回顾了当代文献并在此总结研究结果。越来越多的观察数据表明，使用栓塞保护装置可降低肾动脉支架置入术后肾功能持续下降的风险。也有前瞻性随机数据表明，使用辅助性IIb/IIIa糖蛋白抑制剂和栓塞保护具有协同益处，但这只是一个非常小的系列研究。然而，目前尚无严格对照的前瞻性试验来得出结论，即肾脏保护所增加的风险和费用能被已证实的临床益处所抵消。基于本手稿中汇编的文献，我们确实认为在一些高危患者中应考虑使用EPDs。
