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Danenberg H, Vaknin-Assa H, Makkar R, Virmani R, Manevich L, Codner P, Patel V, Finn AV, Landes U, Rubinshtein R, Bar A, Barnea R, Mezape Y, Teichman E, Eli S, Weisz G, Kornowski R. First-in-human study of the CAPTIS embolic protection system during transcatheter aortic valve replacement. EUROINTERVENTION 2023; 19:e948-e952. [PMID: 37916296 PMCID: PMC10719740 DOI: 10.4244/eij-d-23-00465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Stroke and other clinically significant embolic complications are well documented in the early period following transcatheter aortic valve replacement (TAVR). The CAPTIS device is an embolic protection system, designed to provide neurovascular and systemic protection by deflecting debris away from the brain's circulation, capturing the debris and thus avoiding systemic embolisation. AIMS We aimed to study the safety and feasibility study of the CAPTIS complete cerebral and full-body embolic protection system during TAVR. METHODS A first-in-human study investigated the safety, feasibility and debris capturing ability of CAPTIS during TAVR. Patients were followed for 30 days. The primary endpoints were device safety and cerebrovascular events at 72 hours. RESULTS Twenty patients underwent TAVR using balloon-expandable or self-expanding valve systems. CAPTIS was successfully delivered, positioned, deployed, and retrieved in all cases, and TAVR was successfully completed without device-related complications. No cerebrovascular events were observed. High numbers of debris particles were captured in all patients. CONCLUSIONS The use of the CAPTIS full-body embolic protection system during TAVR was safe, and it captured a substantial number of debris particles. No patient suffered from a cerebrovascular event. A randomised clinical trial is warranted to prove its efficacy.
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Affiliation(s)
- Haim Danenberg
- Wolfson Medical Center, Holon, Israel
- The Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Hana Vaknin-Assa
- The Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
- Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | | | | | - Lisa Manevich
- Wolfson Medical Center, Holon, Israel
- The Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Pablo Codner
- The Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
- Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Vivek Patel
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Uri Landes
- Wolfson Medical Center, Holon, Israel
- The Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Ronen Rubinshtein
- Wolfson Medical Center, Holon, Israel
- The Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Alon Bar
- Wolfson Medical Center, Holon, Israel
- The Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Rani Barnea
- The Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
- Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | | | | | - Sigal Eli
- Filterlex Medical Ltd, Caesarea, Israel
| | - Giora Weisz
- Filterlex Medical Ltd, Caesarea, Israel
- NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Ran Kornowski
- The Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
- Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
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Hiranuma W, Murata Y, Matsuoka T, Minagawa T, Shimizu T, Kawamoto S. Non-occlusive mesenteric ischemia after trans-catheter aortic valve implantation with thyroid storm: A case report. J Cardiol Cases 2022; 27:19-22. [PMID: 36618842 PMCID: PMC9808444 DOI: 10.1016/j.jccase.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/03/2022] [Accepted: 09/11/2022] [Indexed: 11/07/2022] Open
Abstract
Non-occlusive mesenteric ischemia (NOMI) is a rare but well-known life-threatening disease. However, reports on NOMI following trans-catheter aortic valve implantation (TAVI) are limited. This report presents a case of NOMI after trans-apical (TA) TAVI with thyroid storm. A 73-year-old man was admitted for a planned aortic valve surgery. Because he had severe aortic calcification and a right renal tumor that was suspected to be malignant, TA-TAVI was performed. At 61 h after TAVI, the patient complained of abdominal pain, and contrast-enhanced computed tomography showed ischemic necrosis of the cecum to the ascending colon. An ileocecal resection was performed emergently. He was extubated 61 h postoperatively, but severe delirium, high fever, and atrial fibrillation persisted. Due to a history of Basedow's disease, he was diagnosed with thyroid storm and treated with thiamazole and supportive care. The general status gradually improved, and he was transferred to the rehabilitation unit on the 17th postoperative day. We encountered a case of NOMI following TA-TAVI with a thyroid storm, which made it difficult to understand the patient's medical condition. Learning objective The occurrence of non-occlusive mesenteric ischemia after trans-catheter aortic valve implantation is rare but possible, and a thyroid storm could occur even after a less invasive surgery. It is important to perform postoperative management while considering the possible occurrence of this condition.
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Affiliation(s)
- Wakiko Hiranuma
- Corresponding author at: Department of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyaginoku, Sendai, Miyagi 983-8536, Japan.
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Ding P, Zhou Y, Long KL, Zhang S, Gao PY. Acute mesenteric ischemia due to percutaneous coronary intervention: A case report. World J Clin Cases 2022; 10:10244-10251. [PMID: 36246830 PMCID: PMC9561597 DOI: 10.12998/wjcc.v10.i28.10244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/01/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is extensively used to treat acute coronary syndromes (ACS). Acute mesenteric ischemia is a life-threatening disease if untreated.
CASE SUMMARY An 81-year-old female presented with 3 d of lethargy and 1 d of dyspnea. On November 16, 2021, the patient developed a coma. Her oxygen saturation dropped to 70%-80%, the patient was admitted to the intensive care unit for further treatment. Chest computed tomography (CT) showed chronic bronchitis, emphysema, and multiple lung infections. Abdominal CT scan showed no obvious abnormalities, but have severely calcified abdominal vessels. The patient received assisted ventilation, and vasoactive, and anti-infection drugs. Troponin level was elevated. Since the patient was in a coma, it could not be determined whether she had chest pain. The cardiologist assumed that the patient had developed ACS; therefore, the patient underwent PCI via the left femoral artery approach, and no obvious abnormalities were found in the left and right coronary arteries. On the second postoperative day, the patient presented with abdominal distension and decreased bowel sounds; constipation was considered and a glycerin enema was administered. On day 4, the patient suddenly lost consciousness, and had decreased blood pressure, abdominal wall swelling with increased tension, and absence of bowel sounds. An urgent abdominal CT scan revealed gas in her hepatic portal system with extensive bowel wall necrosis. The patient died on day 5 due to intractable shock.
CONCLUSION The potential serious complications in patients undergoing PCI, especially the patients who are hemodynamically unstable and have severely calcified abdominal vessels, should all be considered.
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Affiliation(s)
- Peng Ding
- Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Yuan Zhou
- Department of Geriatrics, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Kun-Lan Long
- Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Song Zhang
- Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Pei-Yang Gao
- Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
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