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Jimenez Diaz VA, Kapadia SR, Linke A, Mylotte D, Lansky AJ, Grube E, Settergren M, Puri R. Cerebral embolic protection during transcatheter heart interventions. EUROINTERVENTION 2023; 19:549-570. [PMID: 37720969 PMCID: PMC10495748 DOI: 10.4244/eij-d-23-00166] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/17/2023] [Indexed: 09/19/2023]
Abstract
Stroke remains a devastating complication of transcatheter aortic valve replacement (TAVR), with the incidence of clinically apparent stroke seemingly fixed at around 3% despite TAVR's significant evolution during the past decade. Embolic showers of debris (calcium, atheroma, valve material, foreign material) are captured in the majority of patients who have TAVR using a filter-based cerebral embolic protection device (CEPD). Additionally, in systematic brain imaging studies, the majority of patients receiving TAVR exhibit new cerebral lesions. Mechanistic studies have shown reductions in the volume of new cerebral lesions using CEPDs, yet the first randomised trial powered for periprocedural stroke within 72 hours of a transfemoral TAVR failed to meet its primary endpoint of showing superiority of the SENTINEL CEPD. The present review summarises the clinicopathological rationale for the development of CEPDs, the evidence behind these devices to date and the emerging recognition of cerebral embolisation in many non-TAVR transcatheter procedures. Given the uniqueness of each of the various CEPDs under development, specific trials tailored to their designs will need to be undertaken to broaden the CEPD field, in addition to evaluating the role of CEPD in non-TAVR transcatheter heart interventions. Importantly, the cost-effectiveness of these devices will require assessment to broaden the adoption of CEPDs globally.
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Affiliation(s)
- Victor Alfonso Jimenez Diaz
- Cardiology Department, Hospital Álvaro Cunqueiro, University Hospital of Vigo, Vigo, Spain
- Cardiovascular Research Group, Galicia Sur Health Research Institute (IISGS), SERGAS-UVIGO, Vigo, Spain
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Heart Center Dresden University Hospital, Dresden, Germany and Technische Universität Dresden, Dresden, Germany
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, Galway, Ireland and University of Galway, Galway, Ireland
| | | | - Eberhard Grube
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Magnus Settergren
- Heart and Vascular Unit, Karolinska University Hospital, Stockholm, Sweden and Karolinska Institutet, Stockholm, Sweden
| | - Rishi Puri
- Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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Wakabayashi N, Kikuchi Y, Shibagaki K, Kamiya H. Transapical thoracic endovascular aortic repair with a frozen elephant trunk for thoracic aortic aneurysm with shaggy aorta. JTCVS Tech 2021; 8:33-36. [PMID: 34401802 PMCID: PMC8350784 DOI: 10.1016/j.xjtc.2021.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Naohiro Wakabayashi
- Division of Cardiac Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Yuta Kikuchi
- Division of Cardiac Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Keisuke Shibagaki
- Division of Cardiac Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroyuki Kamiya
- Division of Cardiac Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
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Ryomoto M, Tanaka H, Mitsuno M, Yamamura M, Sekiya N, Uemura H, Sato A, Ueda D. A Novel Approach to Prevent Perioperative Stroke in Patients Undergoing Debranching Thoracic Endovascular Aortic Repair with a Mini-Cardiopulmonary Bypass Support. Ann Vasc Surg 2019; 59:143-149. [DOI: 10.1016/j.avsg.2018.09.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/31/2018] [Accepted: 09/29/2018] [Indexed: 11/27/2022]
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Yamauchi T, Kubota S, Hasegawa K. Prevention from Atheroembolization during Thoracic Endovascular Aortic Repair in Patients with Severe Atherosclerosis in the Aorta. Ann Vasc Dis 2019; 12:95-98. [PMID: 30931069 PMCID: PMC6434364 DOI: 10.3400/avd.cr.18-00091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Postoperative ischemic complications, especially cerebral infarction due to atheroembolization following thoracic endovascular aortic repair, can be catastrophic. Herein, we present a maneuver of prevention of cerebral infarction using temporary cerebral arterial perfusion from the femoral artery, with the extracorporeal circuit including roller pump and filter in case of severe atherosclerotic change in thoracic aorta.
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Affiliation(s)
- Takashi Yamauchi
- Department of Cardiovascular Surgery, KKR Sapporo Medical Center, Sapporo, Hokkaido, Japan
| | - Suguru Kubota
- Department of Cardiovascular Surgery, KKR Sapporo Medical Center, Sapporo, Hokkaido, Japan
| | - Kosei Hasegawa
- Department of Cardiovascular Surgery, KKR Sapporo Medical Center, Sapporo, Hokkaido, Japan
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Kossar AP, Takayama H, Patel V, George I. Novel Implementation of a Cerebral Protection System During Ascending Thoracic Endovascular Aortic Repair (TEVAR). Semin Thorac Cardiovasc Surg 2018; 31:218-221. [PMID: 30278271 DOI: 10.1053/j.semtcvs.2018.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 09/26/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Alexander P Kossar
- New York Presbyterian Hospital-Columbia University Medical Center, New York, New York
| | - Hiroo Takayama
- New York Presbyterian Hospital-Columbia University Medical Center, New York, New York
| | - Virendra Patel
- New York Presbyterian Hospital-Columbia University Medical Center, New York, New York
| | - Isaac George
- New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.
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