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Complete filter‐based cerebral embolic protection with transcatheter aortic valve replacement
Author(s) -
Van Gils Lennart,
Kroon Herbert,
Daemen Joost,
Ren Claire,
Maugenest AnneMarie,
Schipper Marguerite,
De Jaegere Peter P.,
Van Mieghem Nicolas M.
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27323
Subject(s) - medicine , embolism , radiology , embolization , thrombus , vertebral artery , valve replacement , common carotid artery , cardiology , surgery , carotid arteries , stenosis
Objectives To evaluate the value of left vertebral artery filter protection in addition to the current filter‐based embolic protection technology to achieve complete cerebral protection during TAVR. Background The occurrence of cerebrovascular events after transcatheter aortic valve replacement (TAVR) has fueled concern for its potential application in younger patients with longer life expectancy. Transcatheter cerebral embolic protection (TCEP) devices may limit periprocedural cerebrovascular events by preventing macro and micro‐embolization to the brain. Conventional filter‐based TCEP devices cover three extracranial contributories to the brain, yet leave the left vertebral artery unprotected. Methods Patients underwent TAVR with complete TCEP. A dual‐filter system was deployed in the brachiocephalic trunk and left common carotid artery with an additional single filter in the left vertebral artery. After TAVR all filters were retrieved and sent for histopathological evaluation by an experienced pathologist. Results Eleven patients received a dual‐filter system and nine of them received an additional left vertebral filter. In the remaining two patients, the left vertebral filter could not be deployed. No periprocedural strokes occurred. We found debris in all filters, consisting of thrombus, tissue derived debris, and foreign body material. The left vertebral filter contained debris in an equal amount of patients as the Sentinel filters. The size of the captured particles was similar between all filters. Conclusions The left vertebral artery is an important entry route for embolic material to the brain during TAVR. Selective filter protection of the left vertebral artery revealed embolic debris in all patients. The clinical value of complete filter‐based TCEP during TAVR warrants further research.