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Embolic Protection and Platelet Inhibition During Renal Artery Stenting
Preservation of renal function is an important objective of renal artery stent procedures. Although atheroembolization can cause renal dysfunction during renal stent procedures, whether adjunctive use of embolic protection devices or glycoprotein IIb/IIIa inhibitors improves renal function is unknow...
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| Published in: | Circulation (New York, N.Y.) N.Y.), 2008-05, Vol.117 (21), p.2752-2760 |
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| container_title | Circulation (New York, N.Y.) |
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| creator | COOPER, Christopher J HALLER, Steven T VIRMANI, Renu DIPPEL, Eric ROCHA-SINGH, Krishna MURPHY, Timothy P KENNEDY, David J SHAPIRO, Joseph I D'AGOSTINO, Ralph D PENCINA, Michael J KHUDER, Sadik COLYER, William STEFFES, Michael BURKET, Mark W THOMAS, William J SAFIAN, Robert REDDY, Bhagat BREWSTER, Pamela ANKENBRANDT, Mary Ann |
| description | Preservation of renal function is an important objective of renal artery stent procedures. Although atheroembolization can cause renal dysfunction during renal stent procedures, whether adjunctive use of embolic protection devices or glycoprotein IIb/IIIa inhibitors improves renal function is unknown.
One hundred patients undergoing renal artery stenting at 7 centers were randomly assigned to an open-label embolic protection device, Angioguard, or double-blind use of a platelet glycoprotein IIb/IIIa inhibitor, abciximab, in a 2x2 factorial design. The main effects of treatments and their interaction were assessed on percentage change in Modification in Diet in Renal Disease-derived glomerular filtration rate from baseline to 1 month using centrally analyzed creatinine. Filter devices were analyzed for the presence of platelet-rich thrombus. With stenting alone, stenting and embolic protection, and stenting with abciximab alone, glomerular filtration rate declined (P |
| doi_str_mv | 10.1161/CIRCULATIONAHA.107.730259 |
| format | article |
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One hundred patients undergoing renal artery stenting at 7 centers were randomly assigned to an open-label embolic protection device, Angioguard, or double-blind use of a platelet glycoprotein IIb/IIIa inhibitor, abciximab, in a 2x2 factorial design. The main effects of treatments and their interaction were assessed on percentage change in Modification in Diet in Renal Disease-derived glomerular filtration rate from baseline to 1 month using centrally analyzed creatinine. Filter devices were analyzed for the presence of platelet-rich thrombus. With stenting alone, stenting and embolic protection, and stenting with abciximab alone, glomerular filtration rate declined (P<0.05), but with combination therapy, it did not decline and was superior to the other allocations in the 2x2 design (P<0.01). The main effects of treatment demonstrated no overall improvement in glomerular filtration rate; although abciximab was superior to placebo (0+/-27% versus -10+/-20%; P<0.05), embolic protection was not (-1+/-28% versus -10+/-20%; P=0.08). An interaction was observed between abciximab and embolic protection (P<0.05), favoring combination treatment. Abciximab reduced the occurrence of platelet-rich emboli in the filters from 42% to 7% (P<0.01).
Renal artery stenting alone, stenting with embolic protection, and stenting with abciximab were associated with a decline in glomerular filtration rate. An unanticipated interaction between Angioguard and abciximab was seen, with combination therapy better than no treatment or either treatment alone.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.107.730259</identifier><identifier>PMID: 18490527</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject><![CDATA[Aged ; Aged, 80 and over ; Angioplasty ; Antibodies, Monoclonal - administration & dosage ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood coagulation. Blood cells ; Blood Pressure ; Cardiology. Vascular system ; Combined Modality Therapy ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Embolism - drug therapy ; Embolism - prevention & control ; Female ; Fundamental and applied biological sciences. Psychology ; Glomerular Filtration Rate ; Hemorrhage ; Humans ; Immunoglobulin Fab Fragments - administration & dosage ; Intraoperative Complications - prevention & control ; Kidney Diseases - prevention & control ; Male ; Medical sciences ; Middle Aged ; Molecular and cellular biology ; Platelet ; Platelet Aggregation Inhibitors - administration & dosage ; Prostheses and Implants ; Prosthesis Implantation ; Renal Artery - surgery ; Renal Artery Obstruction - surgery ; Stents ; Treatment Outcome]]></subject><ispartof>Circulation (New York, N.Y.), 2008-05, Vol.117 (21), p.2752-2760</ispartof><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-1769fd123a48f0be91eb903bc9d807e51c4871b39474167eb54ce76aa69e4c143</citedby><cites>FETCH-LOGICAL-c439t-1769fd123a48f0be91eb903bc9d807e51c4871b39474167eb54ce76aa69e4c143</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20383880$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18490527$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>COOPER, Christopher J</creatorcontrib><creatorcontrib>HALLER, Steven T</creatorcontrib><creatorcontrib>VIRMANI, Renu</creatorcontrib><creatorcontrib>DIPPEL, Eric</creatorcontrib><creatorcontrib>ROCHA-SINGH, Krishna</creatorcontrib><creatorcontrib>MURPHY, Timothy P</creatorcontrib><creatorcontrib>KENNEDY, David J</creatorcontrib><creatorcontrib>SHAPIRO, Joseph I</creatorcontrib><creatorcontrib>D'AGOSTINO, Ralph D</creatorcontrib><creatorcontrib>PENCINA, Michael J</creatorcontrib><creatorcontrib>KHUDER, Sadik</creatorcontrib><creatorcontrib>COLYER, William</creatorcontrib><creatorcontrib>STEFFES, Michael</creatorcontrib><creatorcontrib>BURKET, Mark W</creatorcontrib><creatorcontrib>THOMAS, William J</creatorcontrib><creatorcontrib>SAFIAN, Robert</creatorcontrib><creatorcontrib>REDDY, Bhagat</creatorcontrib><creatorcontrib>BREWSTER, Pamela</creatorcontrib><creatorcontrib>ANKENBRANDT, Mary Ann</creatorcontrib><title>Embolic Protection and Platelet Inhibition During Renal Artery Stenting</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Preservation of renal function is an important objective of renal artery stent procedures. Although atheroembolization can cause renal dysfunction during renal stent procedures, whether adjunctive use of embolic protection devices or glycoprotein IIb/IIIa inhibitors improves renal function is unknown.
One hundred patients undergoing renal artery stenting at 7 centers were randomly assigned to an open-label embolic protection device, Angioguard, or double-blind use of a platelet glycoprotein IIb/IIIa inhibitor, abciximab, in a 2x2 factorial design. The main effects of treatments and their interaction were assessed on percentage change in Modification in Diet in Renal Disease-derived glomerular filtration rate from baseline to 1 month using centrally analyzed creatinine. Filter devices were analyzed for the presence of platelet-rich thrombus. With stenting alone, stenting and embolic protection, and stenting with abciximab alone, glomerular filtration rate declined (P<0.05), but with combination therapy, it did not decline and was superior to the other allocations in the 2x2 design (P<0.01). The main effects of treatment demonstrated no overall improvement in glomerular filtration rate; although abciximab was superior to placebo (0+/-27% versus -10+/-20%; P<0.05), embolic protection was not (-1+/-28% versus -10+/-20%; P=0.08). An interaction was observed between abciximab and embolic protection (P<0.05), favoring combination treatment. Abciximab reduced the occurrence of platelet-rich emboli in the filters from 42% to 7% (P<0.01).
Renal artery stenting alone, stenting with embolic protection, and stenting with abciximab were associated with a decline in glomerular filtration rate. An unanticipated interaction between Angioguard and abciximab was seen, with combination therapy better than no treatment or either treatment alone.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angioplasty</subject><subject>Antibodies, Monoclonal - administration & dosage</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood coagulation. Blood cells</subject><subject>Blood Pressure</subject><subject>Cardiology. Vascular system</subject><subject>Combined Modality Therapy</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Embolism - drug therapy</subject><subject>Embolism - prevention & control</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Glomerular Filtration Rate</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Immunoglobulin Fab Fragments - administration & dosage</subject><subject>Intraoperative Complications - prevention & control</subject><subject>Kidney Diseases - prevention & control</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Molecular and cellular biology</subject><subject>Platelet</subject><subject>Platelet Aggregation Inhibitors - administration & dosage</subject><subject>Prostheses and Implants</subject><subject>Prosthesis Implantation</subject><subject>Renal Artery - surgery</subject><subject>Renal Artery Obstruction - surgery</subject><subject>Stents</subject><subject>Treatment Outcome</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><recordid>eNpVkMtOwzAQRS0EoqXwCygsYJdix05sL6NQ2koVrUq7jhxnAkF5FNtZ9O8JNAKxGs3VuTPSQeiO4CkhEXlMlttkv4p3y_VLvIinBPMppzgI5RkakzBgPgupPEdjjLH0OQ2CEbqy9qNfI8rDSzQigkkcBnyM5rM6a6tSexvTOtCubBtPNbm3qZSDCpy3bN7LrPzJnzpTNm_eFhpVebFxYI7eq4PG9ek1uihUZeFmmBO0f57tkoW_Ws-XSbzyNaPS-YRHsshJQBUTBc5AEsgkppmWucAcQqKZ4CSjknFGIg5ZyDTwSKlIAtOE0Ql6ON09mPazA-vSurQaqko10HY25ZiLiESiB-UJ1Ka11kCRHkxZK3NMCU6_Lab_LfYxT08W--7t8KTLasj_moO2HrgfAGW1qgqjGl3aXy7AVFAhMP0CR2Z7zA</recordid><startdate>20080527</startdate><enddate>20080527</enddate><creator>COOPER, Christopher J</creator><creator>HALLER, Steven T</creator><creator>VIRMANI, Renu</creator><creator>DIPPEL, Eric</creator><creator>ROCHA-SINGH, Krishna</creator><creator>MURPHY, Timothy P</creator><creator>KENNEDY, David J</creator><creator>SHAPIRO, Joseph I</creator><creator>D'AGOSTINO, Ralph D</creator><creator>PENCINA, Michael J</creator><creator>KHUDER, Sadik</creator><creator>COLYER, William</creator><creator>STEFFES, Michael</creator><creator>BURKET, Mark W</creator><creator>THOMAS, William J</creator><creator>SAFIAN, Robert</creator><creator>REDDY, Bhagat</creator><creator>BREWSTER, Pamela</creator><creator>ANKENBRANDT, Mary Ann</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20080527</creationdate><title>Embolic Protection and Platelet Inhibition During Renal Artery Stenting</title><author>COOPER, Christopher J ; HALLER, Steven T ; VIRMANI, Renu ; DIPPEL, Eric ; ROCHA-SINGH, Krishna ; MURPHY, Timothy P ; KENNEDY, David J ; SHAPIRO, Joseph I ; D'AGOSTINO, Ralph D ; PENCINA, Michael J ; KHUDER, Sadik ; COLYER, William ; STEFFES, Michael ; BURKET, Mark W ; THOMAS, William J ; SAFIAN, Robert ; REDDY, Bhagat ; BREWSTER, Pamela ; ANKENBRANDT, Mary Ann</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c439t-1769fd123a48f0be91eb903bc9d807e51c4871b39474167eb54ce76aa69e4c143</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angioplasty</topic><topic>Antibodies, Monoclonal - administration & dosage</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood coagulation. Blood cells</topic><topic>Blood Pressure</topic><topic>Cardiology. Vascular system</topic><topic>Combined Modality Therapy</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Embolism - drug therapy</topic><topic>Embolism - prevention & control</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Glomerular Filtration Rate</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Immunoglobulin Fab Fragments - administration & dosage</topic><topic>Intraoperative Complications - prevention & control</topic><topic>Kidney Diseases - prevention & control</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Molecular and cellular biology</topic><topic>Platelet</topic><topic>Platelet Aggregation Inhibitors - administration & dosage</topic><topic>Prostheses and Implants</topic><topic>Prosthesis Implantation</topic><topic>Renal Artery - surgery</topic><topic>Renal Artery Obstruction - surgery</topic><topic>Stents</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>COOPER, Christopher J</creatorcontrib><creatorcontrib>HALLER, Steven T</creatorcontrib><creatorcontrib>VIRMANI, Renu</creatorcontrib><creatorcontrib>DIPPEL, Eric</creatorcontrib><creatorcontrib>ROCHA-SINGH, Krishna</creatorcontrib><creatorcontrib>MURPHY, Timothy P</creatorcontrib><creatorcontrib>KENNEDY, David J</creatorcontrib><creatorcontrib>SHAPIRO, Joseph I</creatorcontrib><creatorcontrib>D'AGOSTINO, Ralph D</creatorcontrib><creatorcontrib>PENCINA, Michael J</creatorcontrib><creatorcontrib>KHUDER, Sadik</creatorcontrib><creatorcontrib>COLYER, William</creatorcontrib><creatorcontrib>STEFFES, Michael</creatorcontrib><creatorcontrib>BURKET, Mark W</creatorcontrib><creatorcontrib>THOMAS, William J</creatorcontrib><creatorcontrib>SAFIAN, Robert</creatorcontrib><creatorcontrib>REDDY, Bhagat</creatorcontrib><creatorcontrib>BREWSTER, Pamela</creatorcontrib><creatorcontrib>ANKENBRANDT, Mary Ann</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>COOPER, Christopher J</au><au>HALLER, Steven T</au><au>VIRMANI, Renu</au><au>DIPPEL, Eric</au><au>ROCHA-SINGH, Krishna</au><au>MURPHY, Timothy P</au><au>KENNEDY, David J</au><au>SHAPIRO, Joseph I</au><au>D'AGOSTINO, Ralph D</au><au>PENCINA, Michael J</au><au>KHUDER, Sadik</au><au>COLYER, William</au><au>STEFFES, Michael</au><au>BURKET, Mark W</au><au>THOMAS, William J</au><au>SAFIAN, Robert</au><au>REDDY, Bhagat</au><au>BREWSTER, Pamela</au><au>ANKENBRANDT, Mary Ann</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Embolic Protection and Platelet Inhibition During Renal Artery Stenting</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2008-05-27</date><risdate>2008</risdate><volume>117</volume><issue>21</issue><spage>2752</spage><epage>2760</epage><pages>2752-2760</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Preservation of renal function is an important objective of renal artery stent procedures. Although atheroembolization can cause renal dysfunction during renal stent procedures, whether adjunctive use of embolic protection devices or glycoprotein IIb/IIIa inhibitors improves renal function is unknown.
One hundred patients undergoing renal artery stenting at 7 centers were randomly assigned to an open-label embolic protection device, Angioguard, or double-blind use of a platelet glycoprotein IIb/IIIa inhibitor, abciximab, in a 2x2 factorial design. The main effects of treatments and their interaction were assessed on percentage change in Modification in Diet in Renal Disease-derived glomerular filtration rate from baseline to 1 month using centrally analyzed creatinine. Filter devices were analyzed for the presence of platelet-rich thrombus. With stenting alone, stenting and embolic protection, and stenting with abciximab alone, glomerular filtration rate declined (P<0.05), but with combination therapy, it did not decline and was superior to the other allocations in the 2x2 design (P<0.01). The main effects of treatment demonstrated no overall improvement in glomerular filtration rate; although abciximab was superior to placebo (0+/-27% versus -10+/-20%; P<0.05), embolic protection was not (-1+/-28% versus -10+/-20%; P=0.08). An interaction was observed between abciximab and embolic protection (P<0.05), favoring combination treatment. Abciximab reduced the occurrence of platelet-rich emboli in the filters from 42% to 7% (P<0.01).
Renal artery stenting alone, stenting with embolic protection, and stenting with abciximab were associated with a decline in glomerular filtration rate. An unanticipated interaction between Angioguard and abciximab was seen, with combination therapy better than no treatment or either treatment alone.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>18490527</pmid><doi>10.1161/CIRCULATIONAHA.107.730259</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 2008-05, Vol.117 (21), p.2752-2760 |
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| subjects | Aged Aged, 80 and over Angioplasty Antibodies, Monoclonal - administration & dosage Biological and medical sciences Blood and lymphatic vessels Blood coagulation. Blood cells Blood Pressure Cardiology. Vascular system Combined Modality Therapy Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Embolism - drug therapy Embolism - prevention & control Female Fundamental and applied biological sciences. Psychology Glomerular Filtration Rate Hemorrhage Humans Immunoglobulin Fab Fragments - administration & dosage Intraoperative Complications - prevention & control Kidney Diseases - prevention & control Male Medical sciences Middle Aged Molecular and cellular biology Platelet Platelet Aggregation Inhibitors - administration & dosage Prostheses and Implants Prosthesis Implantation Renal Artery - surgery Renal Artery Obstruction - surgery Stents Treatment Outcome |
| title | Embolic Protection and Platelet Inhibition During Renal Artery Stenting |
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