Novel Implementation of a Cerebral Protection System During Ascending Thoracic Endovascular Aortic Repair (TEVAR)

Kossar, Alexander P.; Takayama, Hiroo; Patel, Virendra I.; George, Isaac

doi:10.1053/j.semtcvs.2018.09.026

Cited by 5 publications

(2 citation statements)

References 10 publications

(11 reference statements)

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“…Consequently, efforts have been made to reduce the risk of periprocedural stroke during TEVAR 76,77 . There are several case reports and series of patients who have undergone TEVAR with a CEPD [78][79][80] . The authors noted that the use of CEPD appeared to reduce the size and distribution of new cerebral infarcts compared with previously reported neuroimaging studies of unprotected TEVAR procedures, suggesting improved protection for the anterior (protected) circulation 73,81 79 .…”

Section: Thoracic Endovascular Aortic Repair Proceduresmentioning

confidence: 99%

Cerebral embolic protection during transcatheter heart interventions

Jimenez Diaz,

Kapadia,

Linke

et al. 2023

EuroIntervention

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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. KEYWORDS • aortic stenosis • cerebral protection • mitral valve repair • other • stroke • TAVR AS aortic stenosis CEPD cerebral embolic protection device DW-MRI diffusion-weighted magnetic resonance imaging SAVR surgical aortic valve replacement TAVR transcatheter aortic valve replacement TCD transcranial Doppler

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Section: Thoracic Endovascular Aortic Repair Proceduresmentioning

confidence: 99%

Cerebral embolic protection during transcatheter heart interventions

Jimenez Diaz,

Kapadia,

Linke

et al. 2023

EuroIntervention

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“…The Sentinel™ cerebral embolic protection device (CPD; Boston Scientific) consists of two inter‐connected filters that are deployed to the brachiocephalic trunk and left common carotid artery through a six French arterial catheter before the main procedure. Sentinel CPD has previously been used in transcatheter aortic valve replacement (TAVR), 5 left atrial appendage closure, 6 percutaneous ventricular assist device implantation, 7 and thoracic endovascular aortic repair 8 . Here, we report a case where a CPD was used to aid pulmonary vein isolation in a patient with a mass on the left atrial (LA) side of the interatrial septum.…”

Section: Introductionmentioning

confidence: 99%

Use of a cerebral protection device to facilitate pulmonary vein isolation in a patient with left atrial mass arising from the interatrial septum

Gopinathannair

Elbey

Eshcol

et al. 2021

Cardiovasc electrophysiol

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Sentinel cerebral embolic protection devices (CPDs) may limit periprocedural cerebrovascular events by preventing micro and macro‐embolization to the brain, and has been used in many cardiology and radiology procedures. We hereby report the use of a Sentinel CPD to facilitate safe and effective atrial fibrillation ablation in a patient with a left atrial mass arising from the interatrial septum.

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