Embolic protection and platelet inhibition during renal artery stenting
Embolic protection and platelet inhibition during renal artery stenting
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DOI：
10.1161/circulationaha.107.730259
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发表时间：
2008-05-27
期刊：
影响因子：
37.8
通讯作者：
Khuder, Sadik
中科院分区：
文献类型：
--
作者：
Cooper, Christopher J.;Haller, Steven T.;Khuder, Sadik
背景-肾功能的保护是肾动脉支架手术的一个重要目的。虽然动脉粥样硬化栓塞可导致肾功能不全，在肾支架手术，无论是连续使用栓塞保护装置或糖蛋白IIb/IIIa抑制剂改善肾功能是unknown.Methods和Results-100例患者接受肾动脉支架在7个中心被随机分配到一个开放标签的栓塞保护装置，Angioguard，或双盲使用血小板糖蛋白IIb/IIIa抑制剂，阿昔单抗，在2X2析因设计中。使用集中分析的肌酐，根据肾脏疾病饮食改良衍生的肾小球滤过率从基线至1个月的百分比变化，评估了治疗的主要效应及其相互作用。分析滤器是否存在富血小板血栓。单纯支架植入、支架植入加栓塞保护、支架植入加阿昔单抗治疗后，肾小球滤过率下降（P < 0.05），但联合治疗后，肾小球滤过率没有下降，且上级2X2设计中的其他分配（P < 0.01）。治疗的主要效果显示，肾小球滤过率没有总体改善;尽管阿昔单抗优于安慰剂（0 +/- 27% vs-10 +/- 20%; P < 0.05），但栓塞保护效果不佳（-1 +/- 28% vs-10 +/- 20%; P=0.08）。观察到阿昔单抗和栓塞保护之间的相互作用（P < 0.05），有利于联合治疗。阿昔单抗将滤过器中富血小板栓子的发生率从42%降低到7%（P < 0.01）。结论：单独肾动脉支架术、带栓塞保护的支架术和带阿昔单抗的支架术均与肾小球滤过率下降相关。观察到Angioguard和阿昔单抗之间的意外相互作用，联合治疗优于无治疗或单独治疗。
Background-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.Methods and Results-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).Conclusions-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.