Histology of debris captured by a cerebral protection system during transcatheter valve-in-valve implantation

Schmidt, Tobias; Schlüter, Michael; Alessandrini, Hannes; Akdag, Ozan; Schewel, Dimitry; Schewel, Jury; Tourdias, Thomas; Kreidel, Felix; Bader, Ralf; Romero, Maria; Ladich, Elena; Virmani, Renu; Schäfer, Ulrich; Kück, Karl‐Heinz; Frerker, Christian

doi:10.1136/heartjnl-2016-309597

Cited by 30 publications

(26 citation statements)

References 27 publications

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“…In >90% of cases this thrombus material was attached to tissue and/or foreign material. The rate of acute thrombus material is in line with the data from other studies utilizing the Sentinel CPS in endovascular procedures (74%–100%) 10, 12, 14, 15. The thrombogenicity of endovascular catheters cannot be avoided completely, yet an ACT level >300 s should be achieved in every left‐sided procedure, especially in long‐lasting procedures such as VT ablation.…”

Section: Discussionsupporting

confidence: 82%

“…Since calcification is 1 major reason for aortic stenosis, it is not surprising that the rate of calcified debris observed during TAVR and valve‐in‐valve procedures was reported to be much higher (46%–73%),14, 15 whereas for MitraClip and LAA closure procedures no calcified debris was found 12, 13…”

Section: Discussionmentioning

confidence: 99%

“…However, in animal studies, no thrombus was seen on the Sentinel CPS and no foreign material has been shown under high‐magnification microscopy to originate from the filters even after manually scraping its surface 12, 14…”

Section: Discussionmentioning

confidence: 99%

“…It is noteworthy that the Sentinel CPS does not protect the left vertebral and subclavian arteries. The placement of the CPS was performed as previously described 12, 13, 14, 15. Briefly, before device placement, the anatomy of the aortic branches was visualized by angiography with a pigtail catheter placed in the ascending aorta.…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, the device demonstrated retrieval of diverse tissue and material and subsequent reduction of cerebral lesions as assessed by CMRI 8, 9, 10. In TAVR procedures, clinical studies revealed evidence of visible debris removed in up to 100% of cases; the device has also been studied in other endovascular procedures, such as interventional left atrial appendage (LAA) closure, transcatheter valve‐in‐valve procedures, and transcatheter mitral valve repair via MitraClip 11, 12, 13, 14. The aim of the present pilot study was to assess the safety and feasibility of the Sentinel CPS during VT ablation procedures in patients with ischemic heart disease and to provide insight into the histo‐pathomorphologic correlates of periprocedural cerebral embolization.…”

Section: Introductionmentioning

confidence: 99%

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Cerebral Protection During Catheter Ablation of Ventricular Tachycardia in Patients With Ischemic Heart Disease

Heeger

Metzner

Schlüter

et al. 2018

JAHA

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BackgroundCatheter ablation of ventricular tachycardia (VT) is associated with the risk of cerebral embolism. The origin of periprocedural brain embolism in the setting of VT ablation is often unknown and strategies to avoid it are sparse. The aim of this study was to assess the safety and feasibility of an endovascular 2‐filter‐based cerebral protection system (CPS) in left ventricular VT ablation procedures in patients with ischemic heart disease. Furthermore, histopathological correlates of periprocedural embolization were investigated.Methods and ResultsIn this pilot study, 11 patients with ischemic heart disease and sustained VT underwent left ventricular catheter ablation under CPS surveillance. The placement of the CPS was conducted before the ablation procedure via the right radial artery. The VT ablation procedure was performed via a combined transaortic and transseptal approach. All VTs were successfully ablated. Placement and retrieval of the CPS was successful and safe in all cases. No periprocedural complications related to the CPS were observed and no periprocedural transient ischemic attack or stroke occurred. Debris captured by the CPS was detected in all patients. Histology revealed that acute thrombus was the most common type of debris (91%), followed by arterial wall tissue (73%) and foreign material (55%). Less frequently found were myocardium (27%), calcification (9%), necrotic core (9%), and valve tissue (9%).ConclusionsCerebral protection during VT ablation seems to be safe and feasible. Ablation procedures of VT are associated with embolization of embolic debris, which was found in every patient.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cerebral Protection During Catheter Ablation of Ventricular Tachycardia in Patients With Ischemic Heart Disease

Heeger

Metzner

Schlüter

et al. 2018

JAHA

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Preprocedural P2Y₁₂ inhibition and decrease in platelet count following transcatheter aortic valve replacement

Ibrahim

Vapheas

Shah

et al. 2019

Cathet Cardio Intervent

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Background Thrombocytopenia after transcatheter aortic valve replacement (TAVR) is associated with adverse clinical outcomes. Whether preprocedural P2Y12 inhibition prevents postprocedural thrombocytopenia is uncertain. Methods This retrospective analysis identified consecutive patients (n = 266) undergoing TAVR between November 2016 and July 2017. Preprocedure clopidogrel load ≥300 mg or maintenance P2Y12 inhibitor therapy defined preprocedural P2Y12 inhibition. Patients who did not consent for the registry (n = 8), with baseline severe thrombocytopenia (<90 × 103 platelets/μL; n = 14), or without baseline platelet count (n = 4) were excluded. The primary outcome was proportion of patients who developed >20% decrease in platelet count from baseline to day 1 post‐TAVR. Results Patients with (n = 134) versus without (n = 106) preprocedural P2Y12 inhibition had no differences in platelet count at baseline. Patients with preprocedural P2Y12 inhibition had a significantly lower proportion of the primary outcome (34.3% vs. 57.5%, p = .001) and a lower absolute decrease in platelet count (32.8 × 103 vs. 45.8 × 103 platelet/μL, p = .01). Of patients without baseline thrombocytopenia (n = 198), a numerically lower rate of patients with versus without preprocedural P2Y12 inhibition developed thrombocytopenia on day 1 post‐TAVR (25.5% vs. 36.4%, p = .1). Conclusion Patients who received preprocedural P2Y12 inhibition prior to TAVR were less likely to demonstrate a decrease in platelet count after TAVR. Prospective studies to further understand the clinical implication of these findings are warranted.

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Impact of anemia on short‐term outcomes after TAVR: A subgroup analysis from the BRAVO‐3 randomized trial

Razuk

Camaj

Cao

et al. 2021

Cathet Cardio Intervent

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Objectives: To determine the prognostic impact of anemia in patients randomized to bivalirudin or unfractionated heparin (UFH) during transcatheter aortic valve replacement (TAVR).Background: Whether the periprocedural use of bivalirudin as compared with UFH in anemic patients undergoing TAVR has an impact on outcomes remains unknown. Methods:The BRAVO-3 trial compared the use of bivalirudin versus UFH in 802 high risk patients undergoing transfemoral TAVR for severe symptomatic aortic stenosis.Patients were stratified according to the presence (defined as hemoglobin levels <13 g/dl in men and <12 g/dl in women) or absence of anemia. The primary outcomes were net adverse cardiac events (NACE; a composite of all-cause mortality,

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Histology of debris captured by a cerebral protection system during transcatheter valve-in-valve implantation

Abstract: Transcatheter VIV procedures were associated with the release of particulate debris into the cerebral circulation in all patients. The type of debris suggests that debris originates predominantly from arterial and valvular passage of the THV.

Cited by 30 publications

References 27 publications

Cerebral Protection During Catheter Ablation of Ventricular Tachycardia in Patients With Ischemic Heart Disease

Cerebral Protection During Catheter Ablation of Ventricular Tachycardia in Patients With Ischemic Heart Disease

Preprocedural P2Y₁₂ inhibition and decrease in platelet count following transcatheter aortic valve replacement

Impact of anemia on short‐term outcomes after TAVR: A subgroup analysis from the BRAVO‐3 randomized trial

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Histology of debris captured by a cerebral protection system during transcatheter valve-in-valve implantation

Abstract: Transcatheter VIV procedures were associated with the release of particulate debris into the cerebral circulation in all patients. The type of debris suggests that debris originates predominantly from arterial and valvular passage of the THV.

Cited by 30 publications

References 27 publications

Cerebral Protection During Catheter Ablation of Ventricular Tachycardia in Patients With Ischemic Heart Disease

Cerebral Protection During Catheter Ablation of Ventricular Tachycardia in Patients With Ischemic Heart Disease

Preprocedural P2Y12 inhibition and decrease in platelet count following transcatheter aortic valve replacement

Impact of anemia on short‐term outcomes after TAVR: A subgroup analysis from the BRAVO‐3 randomized trial

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Preprocedural P2Y₁₂ inhibition and decrease in platelet count following transcatheter aortic valve replacement