Embol-X Intraaortic Filter and Transaortic Approach for Improved Cerebral Protection in Transcatheter Aortic Valve Implantation

Etienne, Pierre Yves; Papadatos, Spiridon; Pieters, Denis; Khoury, Élie; Alexis, F; Price, Joel; Glineur, David

doi:10.1016/j.athoracsur.2011.05.109

Cited by 27 publications

(14 citation statements)

References 7 publications

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“…Other preventive strategies for embolic strokes such as adequate antiplatelet and anticoagulant medication,[27] embolic protection devices such as deflection,[28] and filtering devices have been studied, but a definitive role is yet to be established. [829]…”

Section: Discussionmentioning

confidence: 99%

Carotid artery disease and periprocedural stroke risk after transcatheter aortic valve implantation

Muluk¹,

Udesh

Mehta

et al. 2017

Ann Card Anaesth

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Objective/Background:To examine the role of carotid stenosis (CS) and other independent risk factors of perioperative stroke, following transcatheter aortic valve implantation (TAVI).Materials and Methods:Using data from the National Inpatient Sample database for analysis, patients who underwent TAVI were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Various preoperative and perioperative risk factors and their association with perioperative strokes were studied.Results:Data on 7566 patients who underwent a TAVI procedure from 2012 to 2013 were extracted. The average age of the patient population was 81.2 ± 0.32 years. The overall perioperative stroke rate in our patient cohort was 2.79%. Majority (94.6%) of the strokes were ischemic. Multivariate analysis showed the following independent risk factors for perioperative strokes after TAVI: female gender odds ratio (OR) = 2.25 (95% confidence interval [CI], 1.42–3.57), higher van Walraven score OR = 6.6 (95% CI = 3.71–11.73), bilateral CS OR = 4.46 (95% CI = 2.03–9.82), and TAVI with a cardiac procedure done under cardiopulmonary bypass OR = 2.84 (95% CI = 1.57–5.14).Conclusion:Bilateral carotid disease is a significant risk factor for perioperative strokes following TAVI. Preoperative screening with carotid Doppler to identify high-risk patients appears to be warranted. In addition, patients of female gender were found to have an increased risk for carotid disease.

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Section: Discussionmentioning

confidence: 99%

Carotid artery disease and periprocedural stroke risk after transcatheter aortic valve implantation

Muluk¹,

Udesh

Mehta

et al. 2017

Ann Card Anaesth

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“…Moreover, recent neuroimaging studies have shown that TAVI is not only associated with clinically apparent neurologic events, but also with new, albeit clinically silent microembolic cerebral lesions on DW-MRI in 80% [2] and even 100% in the very recent PROTAVI-C [Prospective Randomized Outcome TAVI] pilot study [5]. Currently, different protection systems are under investigation [6,7].…”

Section: Commentmentioning

confidence: 96%

Intraaortic Protection From Embolization in Patients Undergoing Transaortic Transcatheter Aortic Valve Implantation

Wendt

Kleinbongard

Knipp

et al. 2015

The Annals of Thoracic Surgery

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“…Because the majority of these episodes are driven by microembolization during the procedure, different neuroprotection devices were developed and clinically tested. There are published data on three emboli protection systems dedicated to TAVI: Embrella (Edwards Lifesciences, Irvine, CA, USA), Montage System (Claret Medical, Inc., Santa Rosa, CA, USA), and SMT (SMT Research and Development, Herzliya Pituach, Israel) [31–33]. …”

Section: Cerebral Protective Devicesmentioning

confidence: 99%

New methods in diagnosis and therapy Stroke following transcatheter aortic valve implantation. Is neuroprotection justified?

Dąbrowski¹,

Witkowski²

2013

pwki

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Degenerative aortic stenosis (AS) is the most frequent type of valvular heart disease. In patients with symptomatic AS surgical aortic valve replacement (SAVR) is a recommended treatment strategy. Due to a high risk of perioperative mortality, up to 30% of patients with AS are considered not suitable for SAVR. In the last 10 years dynamic development of transcatheter aortic valve implantation (TAVI) has been observed as an alternative to SAVR in patients with AS and high risk for surgery. In the two randomized trials published so far and numerous registries, stroke and transient ischemic attack still remain serious periprocedural complications after TAVI. Because the majority of these episodes are driven by microembolization during the procedure, different neuroprotection devices were developed and clinically tested. Embrella and SMT are deflector devices, using a microporous membrane mounted on a nitinol frame, designed to cover the ostia of the brachiocephalic trunk and the left carotid artery. The Claret System is designed to filter cerebral blood flow within the ostia of the brachiocephalic trunk, as well as in the left common carotid artery. Randomized clinical data have demonstrated that TAVI is associated with more neurological events compared to SAVR. However, to date the efficacy of the neuroprotection systems has not been assessed in randomized trials. Before we know the results of such trials, the use of the devices should be limited to patients at high risk of neurological complications, such as patients with previous stroke, massive calcification on aortic leaflets, annulus and porcelain aorta.

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Embol-X Intraaortic Filter and Transaortic Approach for Improved Cerebral Protection in Transcatheter Aortic Valve Implantation

Cited by 27 publications

References 7 publications

Carotid artery disease and periprocedural stroke risk after transcatheter aortic valve implantation

Carotid artery disease and periprocedural stroke risk after transcatheter aortic valve implantation

Intraaortic Protection From Embolization in Patients Undergoing Transaortic Transcatheter Aortic Valve Implantation

New methods in diagnosis and therapy Stroke following transcatheter aortic valve implantation. Is neuroprotection justified?

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