What can be done for cerebral embolic protection in TAVI? Analysis in the light of 10 years’ experience with protected carotid artery stenting

Abstract

In the last 30 years, development of minimally invasive percutaneous procedures to treat cardiovascular defects has been thriving. Although these techniques present obvious advantages, like avoiding cardiopulmonary bypass, the passage of catheter systems and the deployment of devices in the blood circulation can cause particle embolization that may result in stroke. In carotid artery stenting, cerebral embolic protection devices (CEPD) such as filtering membranes have been available for already 10 years. In transcatheter aortic valve implantation (TAVI), the development of CEPD is starting and three membrane-based devices are in clinical trials. There are controversial discussions about the efficacy of CEPD in TAVI. The experience with CEPD in carotid artery stenting can help to understand some of the technical issues and shortcomings of current devices and thereby ultimately reduce cerebral complication risks during TAVI procedures.

Incidence and Risk Factors for Infection Following Transcatheter Aortic Valve Implantation

“…The mechanism for this association may be multifactorial, including an increased risk of aspiration or use of urinary catheters. Evaluation of embolic protection devices to reduce the risk of embolic stroke following TAVI is warranted, and their use may also reduce the risk of infection 10 . Optimizing and reducing the use of urinary catheters may contribute to lowering the risk of postprocedural urinary tract infections.…”

An Ultrasound Model to Predict the Short-Term Effects of Endovascular Stent Placement in the Treatment of Carotid Artery Stenosis

“…In recent years, with the application of cerebral protection devices, endovascular stent placement (ESP) has become widely popularized among neurosurgeons in the treatment of patients. However, inappropriate selection of indications, variable postoperative outcomes, and in-stent restenosis are still common problems (4)(5)(6).…”