Novel use of the Sentinel cerebral protection device during thrombosed septal occluder explant and Atriclip appendage closure

Phase-contrast synchrotron X-ray microtomography (pcSyncX) based on the highly coherent X-ray beam has previously been used to visualize the microstructures of biologic specimens, but it has never been used to evaluate embolic debris adherent on a cerebral protection device (CPD). The purpose of this study was to demonstrate the feasibility of pcSyncX for evaluating embolic debris during carotid artery stenting (CAS). Five patients (four males, age range 67–77 years) with severe carotid artery stenosis underwent CAS. The retrieved CPD was exposed to synchrotron radiation and 1000 pcSyncX projection images were obtained by rotating the CPD through 180°. An X-ray shadow of a CPD was converted into a visual image by the scintillator. After microtomographic reconstruction, the three-dimensionally reconstructed images were further segmented into the embolic debris and CPD. The total volume of emboli was calculated by summing the volume at each scanning level. The number of membrane pores covered by emboli as seen from the outer surface was counted and the percentage of covered area was calculated. Embolic debris was clearly demonstrated not only on the inner surface and within pores but also on the outer surface of the CPD. The mean total volume of embolic debris was 0.538 × 10–6 mm3(range 0.225–0.965 × 10–6 mm3). Most (61.5%) of the debris was located at the apical one-third of the CPD and 20.8% of the pore area was covered by debris.

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In Vitro Comparison of Four Cerebral Protection Filters for Preventing Human Plaque Embolization during Carotid Interventions

Journal of Endovascular Therapy ◽

10.1177/152660280200900612 ◽

2002 ◽

Vol 9 (6) ◽

pp. 793-802 ◽

Cited By ~ 32

Author(s):

Stefan Müller-Hülsbeck ◽

Thomas Jahnke ◽

Carsten Liess ◽

Christoph Glass ◽

Friedrich Paulsen ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Bifurcation ◽

External Carotid Artery ◽

Cerebral Protection ◽

External Carotid ◽

Carotid Angioplasty ◽

Protection Device ◽

Fluid Medium ◽

Vitro Model

Purpose: To evaluate in an in vitro bench-top model the efficacy of 4 filtration devices designed for cerebral protection during carotid angioplasty. Methods: Embolization during carotid angioplasty was simulated with human plaque material (8 to 12 particles weighing 6.02 ± 0.10 mg) in an open flow model with the aortic arch and carotid bifurcation made from elastic silicone tubes and saline used as the fluid medium. The 500 to 1500-µm particles were injected into the internal carotid artery (ICA) in front of the test protection device, which was deployed 5 cm distal to the bifurcation. Particles getting past the protection device or flowing into the external carotid artery (ECA) were caught in 100-µm filters and weighed. Ten trials were made on each of 4 devices: Angioguard, FilterWire EX, TRAP, and NeuroShield. All were deployed according to the manufacturers' directions except the FilterWire, which was manually repositioned in all tests to eliminate a gap between the filter and the tube wall. Results: The lowest weight of missed particles in the effluent was obtained with the NeuroShield (0.05 ± 0.04 mg, 0.8% of injected particle weight) and FilterWire (0.08 ± 0.05 mg, 1.3%; p=0.254 compared to NeuroShield, p=0.006 versus TRAP). The weight of particles missed by the TRAP device (0.16 ± 0.06 mg, 2.6%; p<0.001 versus NeuroShield and Angioguard, p<0.05 compared to Filter Wire) was higher, and the largest amount of missed particles was observed with the Angioguard filter (0.27 ± 0.06 mg, 4.4%; p<0.001 compared to all). NeuroShield and FilterWire were significantly different (p<0.001) compared to Angioguard and TRAP in a pairwise analysis. No embolization into the ECA occurred. Conclusions: In vitro, none of the tested devices had the ability to completely prevent embolization into the ICA. Comparing current designs, the NeuroShield filter and the FilterWire EX captured the highest percentage of human particles in this in vitro model, probably due to their larger filter volume.

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Management of thrombus formation after electrical isolation of the left atrial appendage in patients with atrial fibrillation

EP Europace ◽

10.1093/europace/euaa174 ◽

2020 ◽

Vol 22 (9) ◽

pp. 1358-1366

Author(s):

Thomas Fink ◽

Feifan Ouyang ◽

Christian-Hendrik Heeger ◽

Vanessa Sciacca ◽

Bruno Reissmann ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Thrombus Formation ◽

Cerebral Protection ◽

Atrial Appendage ◽

Protection Device ◽

Left Atrial Appendage Thrombus ◽

Electrical Isolation

Abstract Aims Left atrial appendage (LAA) electrical isolation (LAAEI) in addition to pulmonary vein isolation is an emerging catheter-based therapy to treat symptomatic atrial fibrillation. Previous studies found high incidences of LAA thrombus formation after LAAEI. This study sought to analyse therapeutic strategies aiming at the resolution of LAA thrombi and prevention of thromboembolism. Methods and results Left atrial appendage electrical isolation was conducted via creation of left atrial linear lesions or cryoballoon ablation. Follow-up including transoesophageal echocardiography was conducted. In patients with LAA thrombus, oral anticoagulation (OAC) was adjusted until thrombus resolution was documented. Percutaneous LAA closure (LAAC) under use of a cerebral protection device was conducted in case of medically refractory LAA thrombi. Left atrial appendage thrombus was documented in 54 of 239 analysed patients who had undergone LAAEI. Thrombus resolution was documented in 39/51 patients (72.2%) with available follow-up after adjustment of OAC. Twenty-nine patients underwent LAAC and 10 patients were kept on OAC after LAAEI. No thromboembolic events or further LAA thrombi were documented after 553 ± 443 days of follow-up in these patients. Persistent LAA thrombi despite adaption of OAC was documented in 12/51 patients. One patient remained on OAC until the end of follow-up, while LAAC with a cerebral protection device was performed in 11 patients in the presence of LAA thrombus without complications. Conclusion Left atrial appendage thrombus formation is common after LAAEI. Adjustment of OAC leads to LAA thrombus resolution in most patients. Left atrial appendage closure in the presence of LAA thrombi might be a feasible option in case of failed medical treatment.

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Endovascular Rescue of a Fused Monorail Balloon and Cerebral Protection Device

Journal of Endovascular Therapy ◽

10.1583/1545-1550(2007)14[600:eroafm]2.0.co;2 ◽

2007 ◽

Vol 14 (4) ◽

pp. 600-604 ◽

Cited By ~ 3

Author(s):

John E. Campbell ◽

Mark C. Bates ◽

Michael Elmore

Keyword(s):

Cerebral Protection ◽

Protection Device

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TCT-687 Cerebral protection device for transcatheter valve-in-valve procedures - the ALSTER data

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2015.08.706 ◽

2015 ◽

Vol 66 (15) ◽

pp. B280-B281

Author(s):

Tobias Schmidt ◽

Ulrich Schäfer ◽

Ozan Akdag ◽

Elena Ladich ◽

Oscar D. Sanchez ◽

...

Keyword(s):

Cerebral Protection ◽

Protection Device ◽

Valve In Valve ◽

Transcatheter Valve

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Locking between a Cerebral Protection Device and a Stent-Delivering Catheter during Carotid Artery Stenting

Interventional Neuroradiology ◽

10.15274/inr-2014-10015 ◽

2014 ◽

Vol 20 (1) ◽

pp. 100-105 ◽

Cited By ~ 5

Author(s):

Jong Hun Lee ◽

Sung Won Youn ◽

Ho Kyun Kim

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Cerebral Protection ◽

Surgical Removal ◽

Protection Device ◽

Preventive Actions

The cerebral protection device (CPD) itself may cause complications, including locking between the CPD and other devices, that may result in catastrophic outcomes requiring surgical removal of these locked devices. We describe a case of locking between a CPD and the stent-delivering catheter during carotid artery stenting, which was safely rescued by endovascular retrieval. The mechanism underlying locking with the CPD as well as preventive actions and maneuvers for rescuing the situation are discussed.

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