Evaluating Embolic Reduction Techniques Concurrent to Infrainguinal Interventions: A Single-Center Experience

Objective. To report a single-center retrospective evaluation of embolic reduction strategies concurrent to infrainguinal atherectomy intervention. Methods. Fifty-five consecutive atherectomy patients from 2011 to 2012 treated with embolic reduction devices were analyzed. Embolic load was stratified by lesion type, atherectomy technique, debris capture effectiveness, and risk factor characteristics. Over 80% of lesions were complex. Baseline stenosis and average lesion length were 94.2 +/- 6.4% and 172.8 +/- 85.5 mm, respectively. Our embolic reduction strategy included a systematic approach using the Proteus device in all cases and then in combination with the SpiderFX for long or complex lesions. Debris was analyzed for count and aggregate surface area. Results. Procedural success was 98.2%, with no in-hospital serious adverse events. The mean aggregated surface area of captured debris was 22 +/- 20 mm(2). Thrombolysis with laser produced the highest amount of embolic load followed by laser, directional, and orbital atherectomy procedures (P<.05). Patients with restenotic/in-stent restenotic lesions produced larger amounts of debris (P<.05). No embolizations were recorded up to discharge. Proteus accounted for two-thirds of the debris captured in our study; its capture efficiency increased as device and lesion length met. An inverse relation was also found between lesion length and embolic protection device capture efficacy (TASC-II B vs D; P<.02). Conclusion. An embolic reduction strategy using the Proteus catheter alone, particularly when Proteus and lesion lengths meet, or with the SpiderFX in complex infrainguinal atherectomy procedures, can be an effective tool. Current findings suggest potential optimization of future "at risk" interventions.