Cerebral embolic protection devices during transcatheter aortic valve implantation: clinical versus silent embolism

Abstract

Cerebrovascular events following transcatheter aortic valve implantation (TAVI) is one of the most devastating complications. Several studies with magnetic resonance or cerebral filters have demonstrated the universal brain embolization after TAVI, in the majority of patients clinically silent. Embolic protection devices (EPD) have been developed as a mechanical barrier to prevent these emboli to reach cerebral vasculature and potentially reduce neurological events. We review the current evidence about EPD in relation to histopathological and cerebral imaging findings and neurological events.

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

“…Cerebral embolic protection devices (CEPDs) have been developed to work as a mechanical barrier to prevent embolic debris from reaching the cerebral vasculature, potentially reducing neurological events during TAVR procedures. The dual-filter-based Sentinel TM Cerebral Protection System (Sentinel) (Boston Scientific, Marlborough, MA, USA) received CE Mark approval in 2013 and Food and Drug Administration (FDA) approval in 2017, and it is now the most widely used CEPD system [ 7 , 8 ].…”

Advancements in Transcatheter Aortic Valve Implantation: A Focused Update

“…CVEs are associated with increased 1-year mortality [ 41 , 42 ], are independent predictors of morbidity during the follow-up and have a major impact on quality of life, by impairing cognitive function and daily abilities [ 43 , 44 ]. CVEs are largely underdiagnosed, mainly due to the absence of a standardized definition and classification [ 44 ], with a thorough neurological examination not part of the routine check-ups after TAVI.…”

“…CPDs can be classified in capturing filters or deflectors: capturing filter devices can retain embolic material while deflector devices reject it towards the descending aorta [ 44 ].…”

“…Sentinel is the most widely used CPD and is usually deployed a few minutes before starting the TAVI procedure and is withdrawn soon after into its own catheter [ 44 , 55 ].…”

Routine use of cerebral protection devices during transcatheter aortic valve implantation: what does the evidence say?

“…Recent data suggested that CEPD use is associated with less overt strokes, lower total lesion volume, and a smaller number of new ischemic lesions detected by post-procedural magnetic resonance imaging (MRI) studies [10,[16][17][18][19] .…”