Comments about the Covidien SpiderFX Embolic Protection Device | Which Medical Device
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Embolic protection devices
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Comments
Comment by Sumaira Commented Dec 12, 2011
Impact factor: 12
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The SpiderFX is a Nitinol mesh distal embolic protection device of the filter type. Most available distal filters are of the perforated polyurethane type.
It is used most commonly during carotid stenting, percutaneous coronary interventions of saphenous vein grafts, occasionally during renal stenting and during percutanous atherectomy of the lower limb.
It has two “unique selling points” which may be particularly relevant to carotid interventions:
1. It offers the option of using a high quality 0.014” wire of the operator’s choice to cross the lesion. The filter is mounted on a separate 0.014” wire that is housed towards the trailing end of the low profile (2.9 F) delivery system. The delivery system with pre-mounted filter is advanced over the working 0.014” wire that had been used to cross the system. The bare or “free” wire is removed and the pre-mounted filter is pushed out of the delivery system into the distal vessel beyond the lesion to be treated with distal protection. The deliver system is removed and retained – the opposite end of the delivery system (with slightly wider bore) becomes the retrieval system for the filter at completion of the procedure.
2. The system comprises two rapid-exchange systems – one for the chosen 0.014” wire used to cross the lesion and the second for the pre-loaded wire-mounted filter
Regarding carotid interventions, Nitinol mesh filters are associated with less flow retardation than membrane mesh filters – the latter may retard flow by about 40% in the ipsilateral middle cerebral artery. Industry work (by Medtronic, focussing on their Interceptor Nitinol mesh filter) demonstrated that after around 8mg of entrapped load, membrane mesh filters stared to reduce through-flow very significantly, whilst Nitinol mesh filters maintained respectable flow even after 30mg of entrapped load. Whether this is achieved at the expense of the entrapment of emboli is yet to be ascertained.