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由于栓塞防护装置可阻止介入治疗过程中产生的碎片栓塞远端动脉,所以此类防护装置被认为有助于降低远端栓塞的发生率。一些远端栓塞防护装置(distal protection devices,DPD)已证明其具有捕获栓塞物的能力并且可减少并发症的发生。粥样硬化性肾动脉狭窄介入治疗(RAI)的荟萃分析显示术后患者的肾功能恶化部分原因可能与栓塞有关,文献回顾表明在RAI过程中多数患者发生了微栓塞和肉眼可见栓塞。DPD应用的早期经验提示,在患者肾动脉解剖条件适合的情况下使用DPD可能有助于保护肾功能。合并使用血小板抑制剂在保护肾功能方面可能具有应用价值。基于目前有限的数据和DPD技术水平,我们建议在RAI中不常规使用DPD,DPD应选择性用于粥样硬化斑块负荷大而且肾动脉解剖条件适合的肾功能不全的高危患者。
Because embolization guards prevent occlusion of distal arteries with fragments created during interventional procedures, such guards are thought to help reduce the incidence of distal emboli. Some distal protection devices (DPDs) have demonstrated their ability to capture emboli and reduce the incidence of complications. A meta-analysis of the interventional treatment of atherosclerotic renal artery stenosis (RAI) suggests that postoperative patients may have a worsening of renal function due to embolism, a literature review showing that most patients underwent microembolization and macroscopic embolization during RAI. Early experience with DPD applications suggests that the use of DPD in patients with anatomical renal arteries may help to protect renal function. The combined use of platelet inhibitors may have value in protecting renal function. Based on the current limited data and DPD skill levels, we recommend that DPD be not routinely used in RAI and that DPD should be used selectively in high-risk patients with atherosclerotic plaque burden and adequate renal artery anatomy.