Atheroembolization and peripheral vascular interventions: the evidence is mounting

Two recently published studies provided firm evidence of embolic showers during percutaneous interventions of the lower extremity arteries.1,7 Multiple microemboli 1 mm were detected in 58.0% of the devices, whereas particles >3 mm where recognized in 12.0% of the filters.1 Those findings are in direct agreement with the Doppler embolic signals reported by Lam et al.,8 as well as with electron microscopy findings by Konig et al.9 The noteworthy incidence of atheroembolization during peripheral revascularization procedures is further supported by data from the Preventing Lower Extremity Distal Embolization Using Embolic Filter Protection (PROTECT) registry.5 Researchers collected macrodebris (defined as >2 mm in diameter and believed to play a clinically significant role) in almost a third of the peripheral angioplasty and/or stenting cases and in >90% of the atherectomy cases, which emphasizes the frequency and potential clinical significance of embolization. [...] there is strong emerging evidence that distal protection devices may effectively safeguard the distal vascular bed during peripheral endovascular procedures.