Embolic protection devices:
what is available?
Jennifer Sugita, Horst Sievert
CardioVascular Center Frankfurt,
Sankt Katharinen
Frankfurt, Germany
Why embolic protection?
• Embolism is the major
source of complications
during carotid
angioplasty
• Patients do not want to
have this in their brain
For these reasons
embolic protection is
used routinely in almost
all centers
How often does embolism
occur during carotid
angioplasty?
Probably 100%
• Transcranial doppler
• In vitro studies
• Distal protection devices
in 70-100% debris is captured
• Distal balloon occlusion
– Percusurge
– TriActiv
Medtronic
Kensey Nash
• Filter
–
–
–
–
–
–
Angioguard XP
Cordis
Mednova XLP
Abbott
Accunet
Guidant
EPI-FilterWire, FilterWire EZ
EPI/Boston
Spider (TRAP XLP)
Microvena/ev3
Rubicon Filter
Rubicon
• Proximal balloon occlusion
Arteria, MO.MA
Percusurge/
Guardwire
(Medtronic)
2.7 F
Retrieval-Catheter 5.4 F
Balloon (3-6) mm
The new TriActiv LFX device
• Distal balloon occlusion
– Percusurge
– TriActiv
Medtronic
Kensey Nash
• Filter
–
–
–
–
–
–
Angioguard XP
Cordis
Mednova XLP
Abbott
Accunet
Guidant
EPI-FilterWire, FilterWire EZ
EPI/Boston
Spider (TRAP XLP)
Microvena/ev3
Rubicon Filter
Rubicon
• Proximal balloon occlusion
Arteria, MO.MA
Angioguard XP (Cordis)
3.2-4.0 F
Retrieval-Catheter 5.1 F
Filter 4-8 mm
Micropores: 100μ
Emboshield (Mednova-Abbott)
2.9 – 3.3 F
Retrieval-Catheter 6 F
Filter 3-6 mm
Micropores: 150μ
Wire separate from filter
Accunet RX (Guidant)
3.5 – 3.7 F
Retrieval-Catheter 6 F
Filter 4.5-7.5 mm
Micropores: 115μ
• Distal balloon occlusion
– Percusurge
– TriActiv
Medtronic
Kensey Nash
• Filter
–
–
–
–
–
–
Angioguard XP
Cordis
Mednova XLP
Abbott
Accunet
Guidant
EPI-FilterWire, FilterWire EZ
EPI/Boston
Spider (TRAP XLP)
Microvena/ev3
Rubicon Filter
Rubicon
• Proximal balloon occlusion
Arteria, MO.MA
EPI-Filter EZ (Boston Scientific)
3.9 F
Retrieval-Catheter 3.9 F
Filter (3.5-5.5) mm
Micropores: 80μ
One size fits all
Spider (ev3)
3.2 F
Retrieval-Catheter 3.2 F
Filter 3-7 mm
Micropores: 48-167μ
Wire of your choice
All these filters need
a delivery catheter
• Distal balloon occlusion
– Percusurge
– TriActiv
Medtronic
Kensey Nash
• Filter
–
–
–
–
–
–
Angioguard XP
Cordis
Mednova XLP
Abbott
Accunet
Guidant
EPI-FilterWire, FilterWire EZ
EPI/Boston
Spider (TRAP XLP)
Microvena/ev3
Rubicon Filter
Rubicon/Boston
• Proximal balloon occlusion
Arteria, MO.MA
Rubicon Filter (Rubicon/Boston)
Without delivery catheter
0.014" wire
5 Struts,
Marker on 3 Struts
Polyurethane
Pore size 100μm
Crossing Profile
Cordis Angioguard
EPI FilterWire EX
Rubicon Filter
ATW .014” Guidewire
• Distal balloon occlusion
– Percusurge
– TriActiv
Medtronic
Kensey Nash
• Filter
–
–
–
–
–
–
Angioguard XP
Cordis
Mednova XLP
Abbott
Accunet
Guidant
EPI-FilterWire, FilterWire EZ
EPI/Boston
Spider (TRAP XLP)
Microvena/ev3
Rubicon Filter
Rubicon
• Proximal balloon occlusion
Arteria, MO.MA
ArteriA
Mo.Ma
Balloon
occlusion of
the common
carotid and the
external carotid
artery
This prevents
distal blood
flow and
embolism
External carotid artery
occlusion balloon
Angioplasty
balloon
Common carotid artery
occlusion balloon
ArteriA
Retrograde
Flow via
Guiding catheter
the
guiding catheter
connected
to the
femoral vein
Lesion crossed
Balloon
angioplasty
Endovascular Clamping Concept
MO.MA Device
External
carotid
balloon
Common
Carotid
Balloon
Flow blockage
and aspiration
of debris
Take Home Messages
• It´s good to have at least some different
embolic protection devices available
• Depending on the anatomy of the
individual patient, filter devices, distal or
proximal occlusion devices may be
preferable
th
6
International Course on
Carotid Angioplasty
ICCA VI
And Other Cerebrovascular Interventions
With Live Case Demonstrations
Frankfurt, Germany
November 02-04, 2006
CardioVascular Center
Frankfurt
Distal Embolic Protection Devices
System
Delivery (F) Retrieval (F)
Filter/Balloon
(mm)
Micropore
s (μ)
Angioguard
3.2-4.0
5.1
4-8
100
Mednova
3.7-3.9
6
3-6
140
E.P.I. XP
3.9
3.9
3.5-5-5
80
E.P.I. EZ
3.2
4.1
3.5-5.5
110
AccuNet
3.5-3.7
6
4.5-7.5
115
3.2
3.2
3-7
48-167
Rubicon
none
4.4
4-6
100
Interceptor
2.5
4.5
4.5-6.5
100
PercuSurge
2.7
5.4
3-6
0
Spider