Manipulation of atherosclerotic lesions with wires, catheters, balloons, stents and other intravascular devices during invasive procedures releases are associated with small, but clinically important and discrepant, rates of procedural complications, including cerebral and myocardial ischaemic events, cranial
nerve injury and access site haematoma. Embolic protection devices (EPDs) may lower the rate of ipsilateral ischaemic events during CAS and are considered by the majority of interventionists to be mandatory during CAS. Embolic protectiondevices can be divided into three distinct types based on their mechanism of
operation: distal occlusion aspiration devices, distal filters and proximal occlusion aspiration devices.
The importance of these devices are discussed in articles on Radcliffe Cardiology’s website, home to a number of cardiology review journals including Interventional Cardiology Review, European Cardiology Review and Arrythmia & Electrophysiology Review. Current evidence suggests improved stroke and death outcomes in contemporary series evaluation proximal EPDs compared with earlier series employing filter-type protection. The use of EPDs has been shown to substantially reduce the risk of major adverse cardiovascular events in patients undergoing saphenous vein graft (SVG) and percutaneous coronary intervention (PCI) although the actual use of
these devices in the real-world is surprisingly low. EPDs are used routinely for carotid stenting and being tested for peripheral and renal artery interventions.
Heart electrophysiology procedures which require catheters threaded to the heart also place patients at risk of embolisms. Invasive management of heart rhythm disorders by heart electrophysiology procedures including catheter ablation and device implantation has been established as the therapy of choice for most cardiac arrhythmias, and the number of patients and complex procedures has increased dramatically. An important way to promote quality in these procedures is by increasing public awareness about the
importance of heart rhythm disorders. This in turn often results in increasing public resources to reduce the impact of heart rhythm disease on society.
