Influence of Mesh Design on Hemodynamic Performance and Embolic Filtration in Distal Embolic Protection Filters

Distal net-type embolic protection filters (EPDn) are widely used during endovascular interventions to reduce embolic complications. However, the impact of mesh design on filtration performance and flow dynamics remains poorly defined.

A controlled in vitro experimental model simulating arterial flow under physiological pulsatile conditions was developed. Four EPDn were evaluated. A standardized bolus of 140 μm microspheres was injected. Filtration performance was assessed using capture efficacy (CE), overall efficacy (OE), and particle leakage fraction (PLF), while hemodynamic impact was quantified by peripheral resistance units (PRU). Morphometric analysis and computational modeling were used to characterize mesh design.

Baseline resistance differed significantly among devices, with the highest PRU observed in EPDn1 (5.42 vs. 0.86-4.50; P < 0.001). After particle capture, EPDn4 showed the greatest increase in resistance (11.07 vs. 0.96-8.33; P < 0.001). CE was highest for EPDn4 (97.84%), followed by EPDn3 (78.67%), EPDn1 (63.39%), and EPDn2 (33.24%) (P < 0.001). PLF was lower in EPDn3 and EPDn4 (0.21 vs. 0.45-0.58; P < 0.01). OE was highest for EPDn4 (77.28%), followed by EPDn3 (62.75%), EPDn1 (35.27%), and EPDn2 (14.17%) (P ≤ 0.01). Structural and computational analyses identified design-related differences that may explain these findings.

Mesh design significantly influences the performance of EPDn. Devices with higher filtration efficiency may increase flow resistance, whereas others preserve hemodynamics at the expense of embolic protection. These trade-offs may have important implications for device selection in endovascular interventions.