scholarly journals Need for Embolic Protection During Transcatheter Aortic Valve Implantation: An Interventionalist’s Perspective on Histopathology Findings

2017 ◽  
Vol 12 (01) ◽  
pp. 36 ◽  
Author(s):  
Herbert G Kroon ◽  
Nicolas MDA Van Mieghem ◽  
◽  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Current Evidence ◽  
Embolic Protection ◽  
Transcatheter Aortic Valve ◽  
Replacement Technique ◽  
Protection Devices ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) is a less invasive aortic valve replacement technique and is indicated for patients with symptomatic severe aortic stenosis and a high operative risk. Cerebral embolisation seems inherent to TAVI, as illustrated by the consistent appearance of new brain lesions on post-procedural MRI studies. Embolic protection devices may capture or deflect embolised material en route to the brain and thus reduce TAVI-related brain injury. Histopathology studies of captured debris revealed a diverse aetiology including recent or organised thrombotic material, tissue originating from the aortic valve, atherosclerotic plaques or myocardium and foreign body components. In this overview we provide a perspective on current evidence and implications for embolic protection devices in the dynamic TAVI field.

scholarly journals Cerebral Embolic Protection in TAVI: Friend or Foe

2019 ◽  
Vol 14 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Michael Teitelbaum ◽  
Rafail A Kotronias ◽  
Luciano A Sposato ◽  
Rodrigo Bagur
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Diffusion Weighted Mri ◽  
Cerebrovascular Accidents ◽  
Embolic Protection ◽  
Transcatheter Aortic Valve ◽  
Ischaemic Attack ◽  
Protection Devices ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Cerebrovascular accidents including stroke or transient ischaemic attack are one of the most feared complications after transcatheter aortic valve implantation. Transcatheter aortic valve implantation procedures have been consistently associated with silent ischaemic cerebral embolism as assessed by diffusion-weighted MRI. To reduce the risk of cerebrovascular accidents and silent emboli, cerebral embolic protection devices were developed with the aim of preventing procedural debris reaching the cerebral vasculature. The authors summarise the available data regarding cerebral embolic protection devices and its clinical significance.

scholarly journals Alternative Access for Transcatheter Aortic Valve Implantation: Current Evidence and Future Directions

2019 ◽  
Vol 2 (1) ◽  
pp. 23-27 ◽  
Author(s):  
JJ Coughlan ◽  
Thomas J Kiernan ◽  
Samer Arnous
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Clinical Investigation ◽  
Severe Aortic Stenosis ◽  
Current Evidence ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Randomised Controlled ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) is the usual technique for patients with severe aortic stenosis who are at high risk for surgical aortic valve replacement. The transfemoral (TF) route is the most commonly used access type, and significant progress in this procedure has greatly increased the proportion of patients who can undergo it. Not all patients are suitable for TF TAVI, however, so other routes, including transapical, transaortic, subclavian, trans-subclavian/transaxillary, transcarotid and transcaval, may need to be used. Evidence on these routes shows promising results but the majority of this is registry data rather than randomised controlled trials, so TF TAVI remains the safest access route and should be considered for most patients. However, in patients who are unsuitable for TF TAVI, alternative access routes are safe and feasible. The challenges concern choosing the best route, the valve to use and skill of the specialist centre. This article provides a overview of options for alternative vascular access in TAVI, the clinical rationale for using them, current evidence and areas for clinical investigation.

Tools and Techniques - Clinical: Embolic protection devices in transcatheter aortic valve implantation

2015 ◽  
Vol 11 (2) ◽  
pp. 247-248 ◽  
Author(s):  
Lennart Van Gils ◽  
Andreas Baumbach ◽  
Dominique Himbert ◽  
Alexandra J. Lansky ◽  
Alec Vahanian ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Embolic Protection ◽  
Transcatheter Aortic Valve ◽  
Protection Devices ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
Tools And Techniques

scholarly journals Cerebral Embolic Protection Devices During Transcatheter Aortic Valve Implantation

Stroke ◽  
2017 ◽  
Vol 48 (5) ◽  
pp. 1306-1315 ◽  
Author(s):  
Rodrigo Bagur ◽  
Karla Solo ◽  
Saleh Alghofaili ◽  
Luis Nombela-Franco ◽  
Chun Shing Kwok ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Embolic Protection ◽  
Transcatheter Aortic Valve ◽  
Protection Devices ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Management and Prevention of Vascular Complications Related to Transcatheter Aortic Valve Implantation and Aortic Aneurysm Repair Procedures – A Technical Note

2010 ◽  
Vol 5 (1) ◽  
pp. 81
Author(s):  
Andrea Pacchioni ◽  
Dimitris Nikas ◽  
Carlo Penzo ◽  
Salvatore Saccà ◽  
Luca Favero ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Aneurysm ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Vascular Complications ◽  
Technical Note ◽  
Closure Device ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) and endovascular aortic repair (EVAR) are increasingly being used as therapeutic options for patients with severe aortic stenosis who are ineligible for surgery and who have aortic aneurysm with suitable anatomical features. These procedures can be associated with severe complications, especially related to vascular access and the use of a large introducer sheath (from 18 to 24 French [Fr]). In this article we describe possible vascular complications emerging during TAVI and EVAR and their appropriate management, beginning with patient selection, the correct way to perform vessel puncture and the use of a vascular closure device, up to the recently proposed cross-over technique, which is thought to minimise the risk of dangerous consequences of vascular damage.

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