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CAPTURE WITH CONFIDENCE
Indicated for Carotids and Lower Extremities

The Emboshield NAV6™ Embolic Protection System, which includes BareWire™ Filter Delivery Wires, allows the guide wire to rotate and advance freely, independent of the Emboshield NAV6™ filter.*

The Emboshield NAV6™ EPS is indicated for use as a guide wire and embolic protection system to contain and remove embolic material (thrombus / debris) while performing angioplasty and stenting procedures in carotid arteries and while performing atherectomy, during standalone procedures or together with PTA and/or stenting, in lower extremity arteries. The diameter of the artery at the site of the Filtration Element placement should be between 2.5 and 7.0 mm.

 

* Data on file at Abbott.

OVERVIEW
CLINICAL EVIDENCE
FEATURES
DEPLOYMENT
ORDERING INFO

Embolic Protection Device for Both Lower Extremity and Carotid Arteries

Captures Effectively to Minimize Downstream Complications1-3
  • Centered wire design prevents bias against the vessel wall for effective debris capture.*
  • Circumferential nitinol frame maintains optimal wall apposition, even on a bend.4
  • Platinum-tungsten frame coils provide excellent visibility.*
  • Two sizes allow for easy selection and minimal lab inventory.
Limits Filter Movement and Maintains Wire Access Through Innovative BareWire™ Design*
  • The unique BareWire™ technology allows the wire to rotate and advance freely, independently of the filter.
  • The filter is designed to stay in place during device delivery.4
  • Continued wire access, after filter is fully retracted, allows for easy delivery of additional therapy.4
Navigates Skillfully Through Carotid and Lower Extremity Vasculature*
  • Various types of BareWires™—distal access, workhorse, and support—are designed for various carotid anatomies.
  • They promote navigational success through torturous anatomy and challenging arches.
Is Compatible with Various Atherectomy Options5
  • Emboshield NAV6™ EPS and BareWire™ are compatible with a variety of atherectomy types.
  • BareWire™ is available in 190 cm and 315 cm lengths.

In carotid procedures, the Emboshield NAV6™ EPS is used during stenting with the RX Acculink™ Carotid Stent System and the Xact™ Carotid Stent System.

  • References
    * Data on file at Abbott.
    1. Bioangiu et al. Comparative analysis of retrieved particulate debris after superficial femoral atherectomy using three different atherectomy methods. EuroIntervention, May 2012.
    2. Bioangiu et al. Analysis of Retrieved Particulate Debris after Superficial Femoral Artery (SFA) Atherectomy Using the Pathway Jetstream G3 device. CCI, May 2011, 77(2) p. S57.
    3. Mendes et al. Clinical significance of embolic events in patients undergoing endovascular femoropopliteal interventions with or without embolic protection devices. JVS, February 2014, 59(2), 359-367.
    4. Test(s) performed by and data on file at Abbott.
    5. Philips Turbo-Elite, Medtronic TurboHawk PPES, and Boston Scientific Jetstream XC and SC. Test(s) performed by and data on file at Abbott.

Embolic Protection Devices can add a layer of protection during endovascular procedures in the lower extremities or carotids. In the lower extremities, downstream complications can be minimized and in the carotids, the stroke rate can be reduced with the use of EPDs1.

Excellent Outcomes: Emboshield NAV6™ EPS Clinical Data

Clinical Findings in Brief

Three trials evaluated carotid stenting with the Emboshield NAV6™ EPS and/or previous generation Abbott products.

  • ACT I: Asymptomatic Carotid Trial I
  • CHOICE: Carotid Stenting for High Surgical-Risk Patients; Evaluating Outcomes Through the CollectIon of Clinical Evidence
  • Protect: Protected Carotid Artery Stenting in Patients at High Risk for Carotid Endarterectomy (CEA)

Summary of Clinical Trial Data for Emboshield NAV6™ Embolic Protection System

  ACT I2
(n = 1,453; carotid stenting n = 1,089)
Asymptomatic patients at standard risk for CEA		 CHOICE3
(n = 17,925)
Symptomatic and asymptomatic patients at high risk for CEA		 PROTECT4
(n = 220)
Symptomatic and asymptomatic patients at high risk for CEA
DSMI
(30 Days)		 3.3% 4.2% 2.3%
DS
(30 Days)		 2.9% 3.8% 1.8%
Death or Major Stroke
(30 Days)		 0.6% 1.4% 0.5%
Freedom from Ipsilateral Stroke 97.8%
(30 Days – 5 Years)		 Not evaluated 98.8%
(31 Days – 3 Years)

DS = Death or stroke DSMI = Death, stroke, or myocardial infarction CEA = Carotid endarterectomy

ACT I Trial2,5

The primary aim of this prospective, multicenter trial was to compare the outcomes of stenting with embolic protection vs carotid endarterectomy.

Patients

The 1,453 patients were randomly assigned to the stenting group (n = 1,089) or the CEA group (n = 364), all of whom met the following criteria:

  • Asymptomatic, severe (> 70%) carotid stenosis
  • ≤ 79 years of age
  • Standard risk for CEA surgical complications

Findings

ACT I Trial
  Carotid Artery Stenting (CAS) Carotid Endarterectomy
Primary composite endpoint: DSMI (at 30 days) and ipsilateral stroke (31 days - 1 year) 3.8% 3.4%
Freedom from ipsilateral stroke (31 days - 5 years) 97.8% 97.3%
Freedom from clinically driven revascularization (5 years, p = 0.05) 98.4% 96.7%
5 year survival 87.1% 89.4%

The authors concluded that:

  • There were no significant differences in long-term (5-year) rates of stroke and survival between the two groups in this large randomized trial.
  • CAS was found to be noninferior to CEA for the primary composite end point: DSMI within 30 days; or ipsilateral stroke within 1 year post procedure.
CHOICE Trial3

With 17,925 patients evaluated, the CHOICE trial represents the largest prospective, single-arm, adjudicated, multicenter CAS data set to date. The CHOICE study also provided additional post-market surveillance of RX Acculink™ Carotid Stent System and Abbott’s embolic protection systems.

Patients

Patient criteria included:

  • Severe stenosis of ≥ 50% for symptomatic patients and ≥ 80% for asymptomatic patients
  • High surgical risk for CEA

There were other notable aspects of the patient population:

  • 22.6% who were age ≥ 80
  • 24.4% who had heavy calcification at the target site

Findings

The 30-day findings included:

CHOICE Trial
  All Patients
(n = 17,925)		 Patients Age < 80
(n = 13,868)
DSMI 4.2% 3.4%
DS 3.8% 3.0%
Death or major stroke 1.4% 1.1%

The investigators concluded that CAS is a viable option for patients at high risk for CEA. In addition, favorable outcomes were observed in patients < 80 years of age.

PROTECT Trial4

Investigators undertook the PROTECT trial (n = 220) in an effort to evaluate the outcomes with improved device technology.

Patients

The PROTECT trial included only patients at high surgical risk for CEA, and severe stenosis:

  • ≥ 50% for symptomatic patients
  • ≥ 80% for asymptomatic patients

Findings

PROTECT Trial
DS (30 days) 1.8%
DSMI (30 days) 2.3%
Death or Major Stroke (30 days) 0.5%
Freedom from Ipsilateral Stroke (31 days – 3 years) 98.8%

These data reveal improved outcomes compared to earlier high-risk CAS trials.

PROTECT Trial: Lower DSMI Rate Outcomes vs Other High Risk Carotid IDE Trials

PROTECT, with Abbott EPS: lower DSMI vs other trials

NOTE: Results from clinical trials are not directly comparable. Information provided for educational purposes only.

  • References
    1. Banerjee A, Sarode K, Mohammad A, et al. Safety and Effectiveness of the Nav-6 Filter in Preventing Distal Embolization During Jetstream Atherectomy of Infrainguinal Peripheral Artery Lesions. J Invasive Cardiol. 2016;28(8):330-333. Kastrup, et al. Early Outcome of Carotid Angioplasty and Stenting With and Without Cerebral Protection Devices: A Systematic Review of the Literature. Stroke, Mar 2003, 34(3):813-9. Mendes et al. Clinical significance of embolic events in patients undergoing endovascular femoropopliteal interventions with or without embolic protection devices. JVS, February 2014, 59(2), 359-367.
    2. Rosenfield K, Matsumura JS, Chaturvedi S, et al. Randomized trial of stent versus surgery for asymptomatic carotid stenosis. N Engl J Med. 2016;374(11):1011-1120.
    3. Metzger DC. The CHOICE prospective trial: carotid stenting in a post-market setting. VIVA 2013.
    4. Matsumura JS, Gray W, Chaturvedi S, et al. Results of carotid artery stenting with distal embolic protection with improved systems: Protected Carotid Artery Stenting in Patients at High Risk for Carotid Endarterectomy (PROTECT) trial. J Vasc Surg. 2012; 55(4):968-976.e5.
    5. Wechsler, LR. Asymptomatic Carotid Stenosis Stenting v. Endarterectomy Trial (ACT I). ISC 2016.
    6. Yadav et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351:1493-501.
    7. Gray et al. Protected carotid stenting in high-surgical-risk patients: The ARCHeR results. JVS 2006;44(2) 258-68.
    8. Xact IFU EL2086784 rev A 2014
    9. Iyer et al. Carotid artery revascularization in high-surgical-risk patients using the Carotid WALLSTENT and FilterWire EX/EZ: 1-year outcomes in the BEACH Pivotal Group. J Am Coll Cardiol. 2008 Jan 29;51(4):427-34
    10. Safian et al. Protected carotid stenting in high-risk patients with severe carotid artery stenosis. J Am Coll Cardiol. 2006;47:2384-2389.
    11. Higashida et al. Evaluation of the Medtronic Exponent Self-Expanding Carotid Stent System With the Medtronic Guardwire Temporary Occlusion and Aspiration System in the Treatment of Carotid Stenosis. Stroke. 2010 Feb;41(2):e102-9.
    12. Hopkins et al. Carotid artery revascularisation in high-surgical-risk patients with the NexStent and the FilterWire EX/EZ: 3-year results from the CABERNET trial. EuroIntervention. 2010;5:917-924.
    13. Clair et al. Neuroprotection during carotid artery stenting using the GORE flow reversal system: 30-day outcomes in the EMPiRE Clinical Study. Catheter Cardiovasc Interv. 2011 Feb 15;77(3):420-9.
    14. Ansel et al. Safety and effectiveness of the INVATEC MO.MA proximal cerebral protection device during carotid artery stenting: results from the ARMOUR pivotal trial. Catheter Cardiovasc Interv. 2010;76:1-8.
    * 30-day death, stroke, and MI plus late (31–365 days) ipsilateral stroke

Unique Features: Filter And BareWire™ Delivery Wires*

FILTER

  • 120-µm PORE SIZE
    Effectively captures debris while also allowing blood flow

  • HIGH-STRENGTH NYLON FILTER MATERIAL
    Is designed to enhance capture efficiency by maintaining wall apposition and protecting the vessel wall from direct contact with the nitinol frame

  • NON-THROMBOGENIC HYDROPHILIC COATING
    Is designed to reduce platelet or protein adhesion

1. BAREWIRE™ TECHNOLOGY
Is a proprietary wire technology that enables guide wire-only access through the lesion and ensures stable filter position

2. PROXIMAL MARKER BAND
Includes proprietary radiopaque markers for smooth tracking through tortuous anatomy

3. NITINOL FRAME
Is designed for outstanding circumferential wall apposition—even on a bend—and collapses into a low-profile wrap down during filter retrieval

4. CENTERED WIRE DESIGN
Prevents filter bias against the vessel wall and allows effective capture in all vessel types

5. PLATINUM TUNGSTEN MARKERS
Are radiopaque markers to convey vessel apposition and deployment status

6. 1-MM PORE-FREE ZONE AT DISTAL TIP
Prevents extrusion of embolic material during blood flow

7. DISTAL MARKER BAND
Includes proprietary radiopaque markers for smooth tracking through tortuous anatomy

8. BAREWIRE™ 0.019” STEP
Acts as a distal stop for the Filtration Element

DELIVERY WIRES FOR FLEXIBILITY AND SUPPORT

There are three types of BareWire™ delivery wires.

Distal Access: A soft BareWire™, it provides extra flexibility for successful access through torturous anatomy

Workhorse: Provides optimal flexibility and support for superb access through most anatomies

Support: Is designed to provide additional support for delivery of the filter in challenging arches

 

Filter Visibility

The deployment status and the vessel apposition can be visually confirmed because of the device’s radiopaque frame.

Fully Deployed
Fully Captured

 

* Data on file at Abbott.

System Utilization: Preparation, Delivery, and Retrieval

Straightforward Preparation

The streamlined Emboshield NAV6™ EPS prep procedure requires three steps. Refer to the Instructions for Use for additional information.

1 Flush in Two Places

At the exit port of the delivery catheter

In the filter, to remove air bubbles

2 Pull the Filter into the Delivery Catheter

Pull until the filter is completely inside the delivery catheter, at which point the gold marker is adjacent to the delivery catheter tip
Gold marker must be next to delivery catheter tip

3 Check the Gold Marker

Visually check to ensure that the filter is fully loaded into the delivery catheter
Gold marker must be next to delivery catheter tip
Instructional Videos
Video: preparing to use Emboshield NAV<sup>6</sup>™ EPS
Streamlined 3-step preparation
Exchange of the BareWire™ from
standard 190 cm to longer 315 cm
Device deployment
Device retrieval

ORDERING INFORMATION

Emboshield NAV6™ Embolic Protection System
PART NUMBER UNCONSTRAINED FILTER DIAMETER VESSEL DIAMETER WIRE LENGTH MINIMUM SHEATH/GUIDE SIZE FILTRATION ELEMENT LENGTH (cm) CROSSING PROFILE (F) MINIMUM SHEATH/GUIDE I.D. REQUIRED
22437-19 (Small) 5.0 mm 2.5-4.8 mm 190 cm 5F / 6F 1.9 2.8 0.070"
22438-19 (Large) 7.2 mm 4.0-7.0 mm 190 cm 5F / 6F 2.3 3.2 0.070"
CONSISTS OF 2 PRIMARY PACKS
PRIMARY PACK
Filtration System:		 PRIMARY PACK
(1) RX Delivery Catheter, (1) Filtration Element, (1) BareWire™ Filter Delivery Wire (Workhorse, 190 cm), (1) Loading Funnel, (1) Introducer, (1) Torque Device, (1) Syringe with Flushing Tip
RX Retrieval Catheter: (1) RX Retrieval Catheter, (1) Torque Device, (1) Syringe Flushing Tip
BareWire™ Filter Delivery Wires (0.014”)*
PART NUMBER WIRE TYPE WIRE LENGTH
22439-19 Distal Access 190 cm
22440-19
22440-31		 Workhorse 190 cm
315 cm
22441-19 Support 190 cm

**BareWires™ are sold in packs of five

IMPORTANT SAFETY INFORMATION

Rx Emboshield NAV6™ Embolic Protection System

INDICATIONS

The Emboshield NAV6™ Embolic Protection System is indicated for use as a guide wire and embolic protection system to contain and remove embolic material (thrombus / debris) while performing angioplasty and stenting procedures in carotid arteries and while performing atherectomy, during standalone procedures or together with PTA and/or stenting, in lower extremity arteries. The diameter of the artery at the site of the Filtration Element placement should be between 2.5 and 7.0 mm.

CONTRAINDICATIONS

The Emboshield NAV6™ Embolic Protection System is contraindicated for use in

  • Patients in whom anticoagulant and / or antiplatelet therapy is contraindicated.
  • Patients with severe vascular tortuosity or anatomy that would preclude the safe introduction of the Guiding Catheter / Introducer Sheath, Embolic Protection System.
  • Patients with a known allergy or hypersensitivity to device materials (Nitinol, Nickel, Titanium) or contrast medium, who cannot be adequately premedicated.
  • Patients with uncorrected bleeding disorders.
  • Lesions in the ostium of the common carotid artery.
  • Inability to cross the lesion with the BareWire™ Filter Delivery Wire.
  • Diffusely diseased vessels where there is no disease-free section in which to deploy the Filtration Element
  • Insufficient straight section of vessel distal to the lesion to permit Filtration Element deployment.

WARNINGS

Use of the device should be restricted to physicians trained to the specifics of the device and to the Instructions for Use. Operators must be knowledgeable of the current medical literature and familiar with the principles, clinical applications, complications, side effects and hazards commonly associated with carotid and lower extremity interventional procedures.

Refer to instructions supplied with all interventional devices to be used with the Emboshield NAV6™ Embolic Protection System for their intended uses, contraindications, and potential complications.

The Emboshield NAV6™ System is supplied sterile. Do not use if the package has been opened or is damaged. Carefully inspect the system components prior to use to verify that they have not been damaged and that the size, shape and condition are suitable for the procedure for which they are to be used. A device or access device that is kinked or damaged in any way should not be used.

Safety and effectiveness of this device as an embolic protection system has not been established in the coronary or cerebral vasculature.

The safety and efficacy of the Emboshield NAV6™ Embolic Protection System has not been demonstrated with carotid stent systems other than the Xact™ or Acculink™ Carotid Stent Systems.

The safety and efficacy of the Emboshield NAV6™ Embolic Protection System has not been demonstrated with atherectomy devices other than Turbo-Elite‡ Laser Atherectomy Catheter, Jetstream‡ Single Cutter (SC) Atherectomy Catheter, Jetstream‡ eXpandable Cutter (XC) Atherectomy Catheter and TurboHawk‡ Peripheral Plaque Excision System.
 

The Emboshield NAV6™ device can only be used with the BareWire™ Filter Delivery Wire. Use of the device with any guide wire other than the BareWire™ Filter Delivery Wire will lead to loss of the Filtration Element during the procedure or an inability to retrieve the Filtration Element.

To reduce the potential for the liberation of emboli during lesion crossing, the device should be carefully manipulated and not advanced against resistance.

If the Filtration Element moves into the stented vessel segment prior to retrieval, DO NOT RETRIEVE. Use the Retrieval Catheter to gently maneuver the Filtration Element distally until it is situated in an unstented portion of vessel. Retrieval should then proceed.

Maintain proper guiding catheter / sheath support throughout the procedure. Ensure that there is enough distance between the proximal tip of the Filtration Element and the most distal tip of any interventional device to be introduced over the Filter Delivery Wire to avoid engagement. The tip of a balloon catheter or a stent delivery system or an atherectomy device should not contact the Filtration Element. Failure to maintain adequate distance could result in inadvertent Filtration Element movement and Stent Delivery System tip / Filtration Element entanglement and / or Filtration Element /Stent entanglement if guide catheter or sheath prolapse occurs.

PRECAUTIONS

Precautions to prevent or reduce clotting should be taken when any interventional device is used. Flush or rinse all devices entering the vascular system with heparinized normal saline or alternative anticoagulant, prior to use.

The Emboshield NAV6™ Embolic Protection System must be used with a guiding catheter or introducer sheath to maintain adequate support for the BareWire™ Filter Delivery Wire throughout the procedure.

Venous access should be available during carotid stenting in order to manage bradycardia and / or hypotension by either pharmaceutical intervention or place of a temporary pacemaker, if needed.

Removal of the BareWire™ Filter Delivery Wire with the Emboshield NAV6™ Filtration Element through any interventional devices other than the Emboshield NAV6™ RX Retrieval Catheter has not been tested.

The minimum expanded stent internal diameter required for retrieval of a large embolic load is 2.5 mm.

ADVERSE EVENTS

As reported in the literature, the following adverse events are potentially associated with carotid stents and embolic protection systems:

  • Allergic reaction or hypersensitivity to latex, contrast agent, anesthesia, stent material (Nitinol, Nickel, Titanium) and drug reactions to anticoagulation, or antiplatelet drugs
  • Vascular access complications which may require transfusion or vessel repair, including:
    • Bleeding (ecchymosis, oozing, hematoma, hemorrhage, retroperitoneal hemorrhage)
    • Arteriovenous fistula, pseudoaneurysm, aneurysm, dissection, perforation/rupture, and laceration
    • Embolism (air, tissue, plaque, thrombotic material or device)
    • Thrombophlebitis
  • Target artery complications which may require additional intervention, including:
    • Total occlusion or abrupt closure
    • Arteriovenous fistula, pseudoaneurysm, aneurysm, dissection, perforation/rupture
    • Embolism (air, tissue, plaque, thrombotic material or device)
    • Stenosis or restenosis
    • Artery, stent, or filter thrombosis / occlusion thrombosis
    • Vessel spasm
  • Cardiac arrhythmias (including conduction disorders, atrial and ventricular arrhythmias)
  • Cardiac ischemic conditions (including myocardial ischemia, myocardial infarction, and unstable or stable angina pectoris)
  • Stroke/Cerebrovascular accident (CVA) and Transient Ischemic Attack (TIA)
  • System organ failures:
    • Cardio Pulmonary failure
    • Renal failure / insufficiency
  • Blood cell disorders including heparin induce thrombocytopenia and other coagulopathy
  • Hypotension/hypertension
  • Peripheral nerve injury
  • Other ischemic conditions/infarct
  • Infection - local and systemic (including postprocedural)
  • Nausea and vomiting
  • Chest pain
  • Edema/Cerebral edema and fluid overload
  • Fever
  • Pain, including headache
  • Hyperperfusion syndrome
  • Other neurologic and systemic complications
  • Cerebral hemorrhage
  • Death

Any adverse event occurring involving the Emboshield NAV6™ Embolic Protection System should be reported immediately to Abbott Vascular, Customer Service: 1-800 227-9902.

AP2946421-WBU Rev. C

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