A dual centre non-randomized study retrospectively analysed 78 renal artery stenting procedures performed between 2002 and 2005 and demonstrated no significant difference in kidney function between patients undergoing renal artery angioplasty and stent procedures receiving distal protection devices and those not receiving distal protection (Table 5).8 They compared 31 patients treated with distal protection devices with 17 patients who received stenting alone and demonstrated that estimated GFR (eGFR) improved in both groups at 6 months,

but that the difference in this increase was not significantly different between those receiving a distal protection device and GSI-IX solubility dmso those not (2.9 mL/min per 1.73 m2 compared with 7.6 mL/min per 1.73 m2, respectively, P = 0.15).

There was PLX3397 also no difference at 12 months, although there were 10 fewer patients overall by this stage. Two patients who received distal protection devices and one patient who received stenting alone required dialysis by the end of 12 months. Of the initial 78 procedures analysed, 13 were excluded because of eGFR > 60 mL/min per 1.73 m2 and 9 were lost to follow up before 6 months. The 25 who received stenting alone underwent adjudication for eligibility to receive a distal protection device and 8 were considered ineligible for anatomical reasons. Thus, this study is prone to bias due to this selection of the control group and the loss to follow up. There have been a number of uncontrolled case series published (Table 6) and these demonstrate that the use of distal protection devices is generally technically CHIR-99021 concentration feasible, results in retrieval of debris in the majority of cases (that would presumably have otherwise lodged in the kidneys), and no excess of complications is reported. The conclusions about renal function are difficult to interpret and based on measurement of serum

creatinine, with or without calculation of the GFR, by the MDRD equation. Outcomes are described in terms of ‘improved’, ‘stabilised’, ‘unchanged’ or ‘deteriorated’, and in some studies, before and after creatinine values are given. A published guideline for renal artery revascularization studies recommends such an approach for renal function outcomes, and use of at least two measurements of serum creatinine before and after the procedure to reduce the influence of variation that might arise from a single measurement.9 In the absence of an appropriate control group in these studies, it is difficult to conclude or deny that there has been benefit from the procedure in terms of kidney function. There are two major types of distal protection devices currently available and although used in the renal circulation, the current devices were designed for either coronary or carotid arteries. The balloon occlusion device deploys a balloon distal to the lesion to occlude the vessel, and trapped material is aspirated before the balloon is deflated and removed.