The Angioguard embolic protection device

Endovascular management of cardiovascular disease is quickly becoming a more popular treatment. The effectiveness in using embolic protection devices (EPDs), such as the Angioguard XP filter, during carotid artery stenting (CAS) is a topic of ongoing controversy and scrutiny. Early clinical results indicate that EPDs can reduce complications associated with CAS. However, the incidence of stroke and postprocedural embolic events are statistically similar when comparing CAS with the gold standard in carotid stenosis repair, carotid endarterectomy (CEA). The focus of this manuscript is the critical evaluation of Angioguard XP with respect to numerous in vitro and ex vivo experiments, and clinical trials that have been conducted by the authors and other researchers to investigate the efficacy of EPDs with the objective of suggesting engineering design considerations for future generations of these devices. Angioguard XP has had mixed performance outcomes in in vitro testing reported in the literature. In our laboratory, this device had undesirable measures of performance in bench-top testing protocols using in vitro flow models. Technical considerations relevant to design of EPDs, such as ideal pore size, effective wall apposition in tortuous geometry and maximization of capture efficiency have not been addressed adequately in the literature. It is likely that in the future both CAS and CEA will coexist as potential forms of treatment in the clinical management of cerebrovascular disease.