Department of Cardiovascular Diseases, The John Ochsner Heart and Vascular Institute, Ochsner Medical Institutions, New Orleans, Louisiana, USA.
Catheter Cardiovasc Interv. 2012 Nov 15;80(6):1019-22. doi: 10.1002/ccd.24289. Epub 2012 Mar 9.
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.
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.
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.
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 (Δ RFC) 14.2 ± 15.2 vs. 6.7 ± 11.7 (P = 0.03) compared with the control group.
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.
我们旨在测量血管造影肾帧数 (RFC)，作为一种对肾血流的定量血管造影评估，以评估与 RAS 相关的动脉粥样栓塞引起的微血管损伤。
与肾动脉支架置入术 (RAS) 相关的动脉粥样栓塞已被认为是成功介入后肾功能恶化的原因。在 RAS 中使用远端栓塞保护装置 (EPD) 已被证明是安全的，在大多数情况下可以捕获碎片。然而，EPD 对肾功能的客观益处很难证明。
将 30 例连续接受无 EPD 的 RAS 治疗的患者（33 个肾脏）作为对照组，与 33 例连续接受 EPD 的 RAS 治疗的患者（33 个肾脏）进行比较，采用 RFC 测量。
对照组的支架置入前和支架置入后的平均 RFC 分别为 30.4 ± 12.1 与 23.7 ± 9.9（P = 0.002），EPD 组分别为 42.6 ± 12.6 与 28.3 ± 9.2（P < 0.0001）。EPD 组的肾血流改善更大，表现为 RFC 的更大降低（Δ RFC）为 14.2 ± 15.2 与 6.7 ± 11.7（P = 0.03），与对照组相比。
EPD 的使用与 RAS 后肾血流（较低的 RFC）的改善密切相关。这表明 EPD 可能有效预防肾动脉粥样栓塞损伤，应进行一项评估 EPD 对 RAS 后肾血流影响的对照试验。
