Carotid artery stenting

Roubin, Gary S.; New, Gishel; Iyer, Sriram S.; Al-Mubarak, Nadim; Vitek, Jiri J.

doi:10.3109/9780203463048-49

Cited by 5 publications

(7 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another important anatomic consideration concerning Sentinel insertion eligibility is the presence of vascular tortuosity. Tortuosity hampers access to the filter-landing zone [ 34 , 35 , 36 ], increasing device manipulation, contrast use, vessel injury risk, and CEPD insertion failure [ 35 ]. Device instructions stipulate that Sentinel should be avoided in patients with “excessive” vessel tortuosity; however, there is no specific definition of what excessive tortuosity means.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Safety of Cerebral Embolic Protection Device Insertion in Bovine Aortic Arch Anatomy

Tagliari

Ferrari

Haager

et al. 2020

JCM

View full text Add to dashboard Cite

Background: Cerebral embolic protection devices (CEPDs) have emerged as a mechanical barrier to prevent debris from reaching the cerebral vasculature, potentially reducing stroke incidence. Bovine aortic arch (BAA) is the most common arch variant and represents challenge anatomy for CEPD insertion during transcatheter aortic valve replacement (TAVR). Methods: Cohort study reporting the SentinelTM Cerebral Protection System insertion’s feasibility and safety in 165 adult patients submitted to a transfemoral TAVR procedure from April 2019 to April 2020. Patients were divided into 2 groups: (1) BAA; (2) non-BAA. Results: Median age, EuroScore II, and STS score were 79 years (74–84), 2.9% (1.7–6.2), and 2.2% (1.6–3.2), respectively. BAA was present in 12% of cases. Successful two-filter insertion was 86.6% (89% non-BAA vs. 65% BAA; p = 0.002), and debris was captured in 95% (94% non-BAA vs. 95% BAA; p = 0.594). No procedural or vascular complications associated with Sentinel insertion and no intraprocedural strokes were reported. There were two postprocedural non-disabling strokes, both in non-BAA. Conclusion: This study demonstrated Sentinel insertion feasibility and safety in BAA. No procedural and access complications related to Sentinel deployment were reported. Being aware of the bovine arch prevalence and having the techniques to navigate through it allows operators to successfully use CEPDs in this anatomy.

show abstract

Section: Discussionmentioning

confidence: 99%

Feasibility and Safety of Cerebral Embolic Protection Device Insertion in Bovine Aortic Arch Anatomy

Tagliari

Ferrari

Haager

et al. 2020

JCM

View full text Add to dashboard Cite

show abstract

“…12 Repeated attempts to advance catheters through an angulated vessel may cause endothelial damage or dislodge debris, ultimately causing cerebral emboli and ischemia. 10,16 Besides vascular morphology, the aortic arch anatomy has also been considered a key factor in the success of neuro-interventional procedures. The most common variants in the branching pattern of the aortic arch are bovine arch types 1 and 2 with a prevalence ranging from 8% to 30%.…”

Section: Discussionmentioning

confidence: 99%

“…However, complex anatomy of the aortic arch and the supra‐aortic vessels can challenge Sentinel‐CPS application 7–9 . Especially vascular tortuosity has been reported to be a possible cause of technical failure to appropriately deliver filter‐based protection devices, which might expose the patient to a risk of atheroembolism from the arch, increased contrast administration, and vessel injury 7,10–12 . Objective data determining anatomical characteristics and potential cut‐off values that might influence the procedural success of Sentinel‐CPS application are lacking.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9] Especially vascular tortuosity has been reported to be a possible cause of technical failure to appropriately deliver filter-based protection devices, which might expose the patient to a risk of atheroembolism from the arch, increased contrast administration, and vessel injury. 7,[10][11][12] Objective data determining anatomical characteristics and potential cut-off values that might influence the procedural success of Sentinel-CPS application are lacking. We, therefore, sought to investigate the impact of anatomic features of the aortic arch and the supra-aortic arteries on technical device failure of Sentinel-CPS application in our patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Anatomical reasons for failure of dual‐filter cerebral embolic protection application in TAVR: A CT‐based analysis

Voss

Campanella

Burri

et al. 2021

Journal of Cardiac Surgery

View full text Add to dashboard Cite

Background: The dual-filter Sentinel™ Cerebral Protection System (Sentinel-CPS) is increasingly used during transcatheter aortic valve replacement (TAVR). However, complex vascular anatomy may challenge Sentinel-CPS deployment.Aim of the study: We sought to investigate the impact of anatomic features of the aortic arch and the supra-aortic arteries on technical device failure of Sentinel-CPS application.Methods: Analysis of the multislice computed tomography pre-TAVR aortograms of all patients undergoing TAVR with Sentinel-CPS between 2016 and 2020 (n = 92) was performed. We investigated the impact of aortic arch anatomy, configuration, and the angles of the supra-aortic arteries, including the determination of vascular tortuosity index on device failure of Sentinel-CPS application.Results: The Sentinel-CPS was applied successfully in 83 patients (90.2%). Device failure in nine patients (9.8%) was due to the infeasibility to perform correct deployment of both filters (n = 7) and to obtain peripheral radial access (n = 2). Patients with a failure of Sentinel-CPS application had a higher right subclavian tortuosity index (217 [92-324] vs. 150 [42-252], p = .046), a higher brachiocephalic tortuosity index (27 [5-51] vs. 10 [0-102], p = 0.033) and a larger angulation of the brachiocephalic artery (59° vs. 39°[7-104], p = .014) compared with patients with successful application. A brachiocephalic angle more than 59°was predictive for device failure. No differences in aortic arch anatomy or common carotid artery tortuosity were detected between the groups.Conclusions: Brachiocephalic tortuosity was found to be associated with failure of Sentinel-CPS application. Filter-based usage should be avoided in TAVR patients with a brachiocephalic angle more than 59°.

show abstract

“…This could be partly attributed to intravascular device manipulation itself. Catheter tracking and device positioning may dislodge atheromatous debris within the aortic arch and the proximal brain‐supplying filter‐target vessels (brachiocephalic trunk, left common carotid artery) or cause arterial injury (e.g., dissection, vasospasm) 21–24 potentially affecting cerebral tissue perfusion at the microvascular level due to embolization or hypoperfusion 25 . Cerebral oximetry, based on NIRS measurements, has emerged as a valuable noninvasive neuromonitoring tool to assess cerebral tissue oxygen saturation in real‐time and is routinely used in cardiovascular interventions 8,9,26 .…”

Section: Discussionmentioning

confidence: 99%

Effects of a dual‐filter‐based cerebral embolic protection device in transcatheter aortic valve replacement on cerebral oxygen saturation: A prospective pilot study

et al. 2021

View full text Add to dashboard Cite

Purpose The Sentinel Cerebral Protection System (Sentinel‐CPS) is increasingly used in transcatheter aortic valve replacement (TAVR). However, the impact of inserting the Sentinel‐CPS inside the brain‐supplying arteries on cerebral perfusion and oxygenation is unknown. Methods Twenty patients undergoing transfemoral TAVR with (n = 10) and without (n = 10) cerebral embolic protection using the Sentinel‐CPS were prospectively observed. All patients received conscious sedation and cerebral oxygen saturation (rSO2) was continuously measured with near‐infrared spectroscopy (NIRS). The cumulative perioperative cerebral desaturation was calculated for each patient by multiplying rSO2 below an individualized desaturation threshold by time. In addition, rSO2 values at the time of Sentinel‐CPS insertion, filter positioning, and device retraction were analyzed. Results There was no significant difference in cumulative cerebral desaturation in patients with Sentinel‐CPS (median [IQR]) (0 [0/81] s%) and without (median [IQR]) (0 [0/23] s%), p = .762. A total of 6 patients (33.3%) experienced a perioperative decrease in rSO2 below the individualized desaturation threshold (n = 3 with Sentinel‐CPS, n = 3 without Sentinel‐CPS; p = 1.000). Cerebral desaturation was detected during valve deployment (n = 5) and after postdilatation (n = 1). No desaturation events occurred during Sentinel‐CPS insertion, filter positioning, or retraction. Conclusion Our pilot study revealed no difference in cumulative perioperative cerebral desaturation between TAVR with and without Sentinel‐CPS. Catheter‐ and filter‐based manipulations in the brain‐supplying arteries for Sentinel‐CPS application were not associated with a decrease of cerebral perfusion and oxygenation.

show abstract

Carotid artery stenting

Cited by 5 publications

References 19 publications

Feasibility and Safety of Cerebral Embolic Protection Device Insertion in Bovine Aortic Arch Anatomy

Feasibility and Safety of Cerebral Embolic Protection Device Insertion in Bovine Aortic Arch Anatomy

Anatomical reasons for failure of dual‐filter cerebral embolic protection application in TAVR: A CT‐based analysis

Effects of a dual‐filter‐based cerebral embolic protection device in transcatheter aortic valve replacement on cerebral oxygen saturation: A prospective pilot study

Contact Info

Product

Resources

About