Banerjee Avantika, Sarode Karan, Mohammad Atif, Brilakis Emmanouil S, Banerjee Subhash, Shammas Gail A, Shammas Nicolas W
Midwest Cardiovascular Research Foundation, 1622 E. Lombard Street, Davenport, IA 52803 USA.
J Invasive Cardiol. 2016 Aug;28(8):330-3. Epub 2016 May 15.
The risk of distal embolization (DE) during infrainguinal peripheral artery interventions (PAI) is often mitigated by the use of embolic protection devices. There are limited data on the use of filters with the Jetstream (JS) atherectomy device, a rotational cutter with aspiration capacity. The Nav-6 filter is uniquely suited for use with the JS due to its wire compatibility and detachment from the filter; however, data on the off-label use of this combination have not been reported.
Consecutive patients between October 2008 and April 2015 undergoing endovascular infrainguinal PAI with JS were analyzed as part of the Excellence in Peripheral Artery Disease (XL-PAD) registry (NCT01904851). Patients were divided into two subgroups with Nav-6 filter use vs no filter use. Descriptive and univariate analyses were performed.
Among 141 patients (mean age, 67.8 ± 10.8 years; 169 lesions) included in this study, the Nav-6 filter was used in 82 (59%). Use of a filter was more frequent in longer lesions (146 ± 106 mm vs 91 ± 72 mm; P=.01), in more severe stenoses (95% vs 87%; P=.04), and in chronic total occlusions (33% vs 8.3%; P=.01). Patients receiving filters had longer procedure duration (102 ± 51 min vs 66 ± 41 min; P=.01) and longer fluoroscopy times (31 ± 16 min vs 21 ± 10 min; P<.001). Use of the Nav-6 filter with the JS during PAI was associated with numerically lower rates of DE (1.8% vs 8%; P=.10) and similar rates of death and amputation. At 12 months, the target-lesion revascularization rate was higher in the filter group (22% vs 2.7%; P=.02), likely secondary to use of the filter in more complex lesions.
Nav-6 filter during JS atherectomy was predominantly used during complex infrainguinal PAI and was associated with less occurrence of DE.
在股腘以下外周动脉介入治疗（PAI）期间，远端栓塞（DE）的风险通常通过使用栓子保护装置来降低。关于将过滤器与具有抽吸能力的旋转切割器Jetstream（JS）旋切装置联合使用的数据有限。Nav-6过滤器因其与导丝的兼容性以及与过滤器的分离特性，特别适合与JS联合使用；然而，关于这种联合的非标签使用的数据尚未见报道。
作为外周动脉疾病卓越研究（XL-PAD）注册研究（NCT01904851）的一部分，对2008年10月至2015年4月期间连续接受JS血管内股腘以下PAI的患者进行分析。患者被分为使用Nav-6过滤器和未使用过滤器两个亚组。进行描述性和单变量分析。
本研究纳入的141例患者（平均年龄67.8±10.8岁；169处病变）中，82例（59%）使用了Nav-6过滤器。在较长病变（146±106mm对91±72mm；P = 0.01）、更严重狭窄（95%对87%；P = 0.04）和慢性完全闭塞病变（33%对8.3%；P = 0.01）中，过滤器的使用更为频繁。接受过滤器的患者手术时间更长（102±51分钟对66±41分钟；P = 0.01），透视时间更长（31±16分钟对21±10分钟；P < 0.001）。在PAI期间将Nav-6过滤器与JS联合使用在数值上与较低的DE发生率相关（1.8%对8%；P = 0.10），且死亡和截肢发生率相似。在12个月时，过滤器组的靶病变血运重建率更高（22%对2.7%；P = 0.0
