Incidence and Clinical Significance of Distal Embolization Following Percutaneous Interventions Involving the Superficial Femoral Artery

Objectives: Distal embolization may cause organ ischemia following percutaneous peripheral interventions. The purpose of our study is to evaluate the incidence and significance of embolization during percutaneous superficial femoral artery (SFA) interventions using continuous Doppler ultrasound.
Methods: 28 patients underwent successful SFA interventions. A 4-MHz Doppler probe was used for continuous monitoring in the ipsilateral popliteal artery. Distal embolization was registered as microembolic signals (MES). MES were quantitatively assessed during critical portions of the procedure including guide wire crossing , balloon angioplasty and stent deployment. T-Test was used to analyze the quantitative data.
Results: MES were noted in each patient during wire crossing, angioplasty, and stent deployment. The frequency of MES was significantly higher during stent deployment than during wire crossing or balloon angioplasty.(See Figure) MES were detected during atherectomy as well. A higher incidence of MES was noted in lesions with severe calcification and total occlusion. Completion angiograms revealed no significant distal embolization. All patients reported an improvement in symptoms with an average of 0.3 increase in ABI.
Conclusions: While MES were recorded at each step in SFA interventions, the frequency was greatest during stent deployment and in patients with severe calcification and total occlusion. There was no angiographic or clinical sequelae noted in our study. Further study of microembolism with longer follow up is required to confirm these results.