Is embolic protection during renal artery intervention really necessary?

Atherosclerotic renovascular disease is an increasingly recognized cause of both renal function impairment and hypertension, and its presence is associated with increased cardiovascular mortality and dialysis dependence. Although surgical renal revascularization is associated with the most favorable reported renal function outcomes, the significant perioperative mortality and complication rates have resulted in a shift to renal artery percutaneous transluminal angioplasty and stenting (RA-PTAS) as the most frequently performed method of revascularization. Renal function outcomes following RA-PTAS are less favorable, with patients experiencing functional improvement and deterioration with approximately equal frequency in reported series. Distal atheroembolization is thought to occur during RA-PTAS and has been suggested as a potential cause of the disparate renal function outcomes. Distal embolic protection devices primarily used and evaluated in the coronary and cerebrovascular circulations have also been successfully employed during RA-PTAS. Initial clinical results following RA-PTAS with distal embolic protection have been promising, with high rates of technical success, renal function outcomes that approximate those reported with open surgical revascularization, and maintenance of relatively low death and complication rates. Further investigation with controlled comparison groups is warranted before routine use of distal embolic protection can be uniformly endorsed.