scholarly journals Feasibility and Safety of Cerebral Embolic Protection Device Insertion in Bovine Aortic Arch Anatomy

2020 ◽  
Vol 9 (12) ◽  
pp. 4118
Author(s):  
Ana Paula Tagliari ◽  
Enrico Ferrari ◽  
Philipp K. Haager ◽  
Martin Oliver Schmiady ◽  
Luca Vicentini ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Vascular Complications ◽  
Stroke Incidence ◽  
Embolic Protection ◽  
Transcatheter Aortic Valve ◽  
Filter Insertion ◽  
Protection Devices ◽  
Sts Score ◽  
Access Complications ◽  
Bovine Aortic Arch

Background: Cerebral embolic protection devices (CEPDs) have emerged as a mechanical barrier to prevent debris from reaching the cerebral vasculature, potentially reducing stroke incidence. Bovine aortic arch (BAA) is the most common arch variant and represents challenge anatomy for CEPD insertion during transcatheter aortic valve replacement (TAVR). Methods: Cohort study reporting the SentinelTM Cerebral Protection System insertion’s feasibility and safety in 165 adult patients submitted to a transfemoral TAVR procedure from April 2019 to April 2020. Patients were divided into 2 groups: (1) BAA; (2) non-BAA. Results: Median age, EuroScore II, and STS score were 79 years (74–84), 2.9% (1.7–6.2), and 2.2% (1.6–3.2), respectively. BAA was present in 12% of cases. Successful two-filter insertion was 86.6% (89% non-BAA vs. 65% BAA; p = 0.002), and debris was captured in 95% (94% non-BAA vs. 95% BAA; p = 0.594). No procedural or vascular complications associated with Sentinel insertion and no intraprocedural strokes were reported. There were two postprocedural non-disabling strokes, both in non-BAA. Conclusion: This study demonstrated Sentinel insertion feasibility and safety in BAA. No procedural and access complications related to Sentinel deployment were reported. Being aware of the bovine arch prevalence and having the techniques to navigate through it allows operators to successfully use CEPDs in this anatomy.

scholarly journals Insights on Embolic Protection, Repositioning, and Stroke: A Subanalysis of the RESPOND Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Julia Seeger ◽  
Volkmar Falk ◽  
David Hildick-Smith ◽  
Sabine Bleiziffer ◽  
Daniel J. Blackman ◽  
...  
Keyword(s):  
Stroke Risk ◽  
Relative Risk Reduction ◽  
Neurological Complications ◽  
Embolic Protection ◽  
Transcatheter Aortic Valve ◽  
Sts Score ◽  
The Difference ◽  
Ischemic Attack ◽  
The Impact

RESPOND is a prospective, single-arm study enrolling 1014 transcatheter aortic valve replacement (TAVR) patients. The objective of this analysis is to assess the impact of cerebral embolic protection (CEP) devices and prosthetic valve repositioning on the risk of neurologic complications in patients treated with the fully repositionable Lotus Valve in the RESPOND postmarket study. Valve repositioning and CEP use were at the operators’ discretion. Stroke events were adjudicated by an independent medical reviewer. This analysis assessed the baseline differences among patients according to CEP use and valve repositioning and evaluated the neurological complications at 72 hours after TAVR, hospital discharge, and 30-day follow-up. A multivariate analysis was performed to identify the potential predictors of stroke. Of the 996 patients implanted with the Lotus Valve (mean age: 80.8 years, 50.8% female, STS score 6.0 ± 6.9), 92 cases (9.2%) used CEP. The overall rate of acute stroke/transient ischemic attack (TIA) was 3.0% at 72 hours after TAVR. The 72-hour stroke/TIA rate was 1.1% in patients who had CEP and 3.2% in those who did not. Use of CEP was associated with a 2.1% absolute reduction in the risk of acute neurological events (relative risk reduction: 65.6%), although the difference was not statistically significant (p=0.51). Repositioning of the Lotus Valve occurred in 313/996 procedures (31.4%). The 72-hour rate of stroke/TIA was similar in patients who had valve repositioning (2.9%) compared with those who did not (3.1%; p=0.86). The selective use of a CEP device in the RESPOND study was associated with a nonsignificantly lower risk for stroke within 72 hours. The use of the repositioning feature of the Lotus Valve did not increase the stroke risk.

scholarly journals PC058. A Novel Aortic Arch Flow Model to Test the Efficacy of Cerebral Embolic Protection Devices Using Transcranial Doppler

2019 ◽  
Vol 69 (6) ◽  
pp. e220-e221
Author(s):  
Travis J. Vowels ◽  
Priya Kothapalli ◽  
Philip Auyang ◽  
Zsolt Garami ◽  
Alan B. Lumsden
Keyword(s):  
Aortic Arch ◽  
Transcranial Doppler ◽  
Flow Model ◽  
Embolic Protection ◽  
Protection Devices

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 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.

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