Embolic Protection Device Use in Renal Artery Stent Placement

Purpose: The purpose of the present study was to report safety, efficacy, and renal function outcomes with use of the GuardWire embolic protection device (EPD) in renal artery stent placement for patients with renal artery stenosis (RAS) and chronic renal insufficiency (CRI). Materials and Methods: This was a retrospective study of all patients with RAS and CRI treated concomitantly with a GuardWire EPD and renal artery stents from December 2002 through June 2006. Renal function was determined by calculating the estimated glomerular filtration rate (eGFR) according to the Modification of Diet in Renal Disease formula, and subjects were divided into Kidney Disease Outcomes and Quality Initiative (K-DOQI) classes based on baseline eGFR. After revascularization, an improvement from baseline of at least one K-DOQI class was defined as improvement, unchanged K-DOQI class as stabilization, and worsening of at least one K-DOQI class as deterioration. Results: There were 63 patients (54% men) with a mean age of 75.2 years ± 7.7. The mean baseline serum creatinine level and eGFR were 1.87 mg/dL ± 0.6 (range, 1-3.8 mg/dL) and 36.63 mL/min per 1.73 m² ± 11.42 (range, 13.85-59.99 mL/min per 1.73 m²), respectively, and at the last clinical follow-up, the respective measurements were 1.96 mg/dL ± 0.72 and 38.75 mL/min per 1.73 m² ± 13.25 (P = not significant). Over a mean follow-up period of 16 months ± 12, 14 patients (25%) showed improvement, 33 (58%) had stable renal function, and 10 (18%) showed deterioration. There was one GuardWire-related dissection, which was successfully treated with a stent. Conclusions: The GuardWire EPD, used during renal artery stent placement, is safe and was associated with stabilization or improvement in kidney function in 83% of patients with RAS and CRI.