Complete filter‐based cerebral embolic protection with transcatheter aortic valve replacement

Gils, Lennart L. van; Kroon, Herbert; Daemen, Joost; Ren, Claire; Maugenest, Anne-Marie; Schipper, Marguerite M.E.I.; Jaegere, Peter P.P.T. de; Mieghem, Nicolas N.M. van

doi:10.1002/ccd.27323

Cited by 30 publications

(29 citation statements)

References 34 publications

(58 reference statements)

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“…In a small study on eleven patients the left vertebral filter could be deployed in nine cases and it contained debris in an equal amount of patients as the Sentinel filters. The size of the captured particles was similar between all filters indicating that the left vertebral artery is an important entry route for debris to the brain during TAVR . Besides the partial protection issue, the fact worth mentioning is that there is only one size of filter available.…”

Section: Cerebral Protection Systemsmentioning

confidence: 81%

Cerebral embolic protection systems for transcatheter aortic valve replacement

Gąsior

Bijoch

Wojakowski

2018

J Interven Cardiology

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In the recent years, ischemic brain injury related to embolization after transcatheter aortic valve replacement (TAVR) has received increased attention as new embolic protection strategies emerged to protect the brain. Diverse cerebral protection devices have been developed to reduce cerebral embolization during TAVR. These devices work through various mechanisms and are in different stages of clinical translation. This review provides the evidence‐based review of peri‐procedural stroke prevention during TAVR and summarizes currently available cerebral embolic protection devices.

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Section: Cerebral Protection Systemsmentioning

confidence: 81%

Cerebral embolic protection systems for transcatheter aortic valve replacement

Gąsior

Bijoch

Wojakowski

2018

J Interven Cardiology

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“…A total of 16 studies, [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] including 1170 patients (865/305 with/without EPD), fulfilled the inclusion criteria for the qualitative synthesis ( Figure I in the online-only Data Supplement). The mean age was 81.7 years, and 50.2% were female in 14 studies that reported both age and sex.…”

Section: Study Populationmentioning

confidence: 99%

“…[14][15][16][17][18][19][20][21][22][23][26][27][28][29] The presence of baseline atrial fibrillation was reported in 9 studies, [17][18][19]21,22,26,27,29 with a prevalence of 31.6% (285/902 patients). Previous stroke was reported in 14 studies, [14][15][16][17][18][19][20][21][22][23][26][27][28][29] with a prevalence of 10.8% (111/1028 patients). More details can be appreciated in the Results and Tables I and II in the online-only Data Supplement).…”

Section: Study Populationmentioning

confidence: 99%

“…The EPD delivery success rate was reported in all studies [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] and was achieved in 94.5% (804/851) of patients, ranging from 64% to 100%. All-cause mortality was reported in 9 studies [17][18][19][20][21][22][27][28][29] and occurred in 3.0% (27/907) of patients: 9 studies with EPD [17][18][19][20][21][22],27-29 with a 2.4% (15/626) rate and 6 studies without EPD 17,18,22,27-29 with a 2.8% (8/281) rate.…”

Section: Thirty-day Outcomesmentioning

confidence: 99%

“…All-cause mortality was reported in 9 studies [17][18][19][20][21][22][27][28][29] and occurred in 3.0% (27/907) of patients: 9 studies with EPD 17-22,27-29 with a 2.4% (15/626) rate and 6 studies without EPD 17,18,22,[27][28][29] with a 2.8% (8/281) rate. The incidence of stroke was reported in 15 studies [14][15][16][17][18][19][20][21][22][23][25][26][27][28][29] …”

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confidence: 99%

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Cerebral Embolic Protection Devices During Transcatheter Aortic Valve Implantation

Bagur

Solo

Alghofaili

et al. 2017

Stroke

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T ranscatheter aortic valve implantation (TAVI) procedures have been associated with silent ischemic cerebral embolism as assessed by diffusion-weighted magnetic resonance imaging (DW-MRI) or high-intensity transient signals as assessed by transcranial Doppler. [1][2][3][4][5][6] Embolic protection devices (EPD) might reduce the risk of cerebral embolic ischemic lesions, either clinically evident cerebrovascular accidents or silent ischemic lesions in patients undergoing TAVI. Nonetheless, the efficacy of EPD in the TAVI setting has only been investigated in studies with relatively small sample sizesBackground and Purpose-Silent ischemic embolic lesions are common after transcatheter aortic valve implantation (TAVI). The use of embolic protection devices (EPD) may reduce the occurrence of these embolic lesions. Thus, a quantitative overview and credibility assessment of the literature was necessary to draw a robust message about EPD. Therefore, the aim of this meta-analysis was to study whether the use of EPD reduces silent ischemic and clinically evident cerebrovascular events associated with TAVI. Methods-We conducted a comprehensive search to identify studies that evaluated patients undergoing TAVI with or without EPD. Random-effects meta-analyses were performed to estimate the effect of EPD compared with no-EPD during TAVI using aggregate data. Results-Sixteen studies involving 1170 patients (865/305 with/without EPD) fulfilled the inclusion criteria. The EPD delivery success rate was reported in all studies and was achieved in 94.5% of patients. Meta-analyses evaluating EPD versus without EPD strategies could not confirm or exclude any differences in terms of clinically evident stroke (relative risk, 0.70; 95% confidence interval [CI], 0.38-1.29; P=0.26) or 30-day mortality (relative risk, 0.58; 95% CI, 0.20-1.64; P=0.30). There were no significant differences in new-single, multiple, or total number of lesions. The use of EPD was associated with a significantly smaller ischemic volume per lesion (standardized mean difference, −0.52; 95% CI, −0.85 to −0.20; P=0.002) and smaller total volume of lesions (standardized mean difference, −0.23; 95% CI, −0.42 to −0.03; P=0.02). Subgroup analysis by type of valve showed an overall trend toward significant reduction in new lesions per patient using EPD (standardized mean difference, −0.41; 95% CI, −0.82 to 0.00; P=0.05), driven by self-expanding devices. Conclusions-The use of EPD during TAVI may be associated with smaller volume of silent ischemic lesions and smaller total volume of silent ischemic lesions. However, EPD may not reduce the number of new-single, multiple, or total number of lesions. There was only very low quality of evidence showing no significant differences between patients undergoing TAVI with or without EPD with respect to clinically evident stroke and mortality. that are underpowered for the end points studied and, thus, subject to selection biases. Hence, a comprehensive systematic review with a rigorous methodology for quality and credibilit...

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