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Stroke following transcatheter aortic valve implantation. Is neuroprotection justified?

Dąbrowski M, Witkowski A - Postepy Kardiol Interwencyjnej (2013)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus

The Claret CE Pro™ System consists of a proximal filter which is fixed within a flexible nitinol frame. The frame is radiopaque and will expand to oppose and seal to the vessel wall when unsheathed. Following first filter expansion, the system enables the delivery of the distal filter to the left common carotid artery
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Figure 0004: The Claret CE Pro™ System consists of a proximal filter which is fixed within a flexible nitinol frame. The frame is radiopaque and will expand to oppose and seal to the vessel wall when unsheathed. Following first filter expansion, the system enables the delivery of the distal filter to the left common carotid artery

Mentions: The Claret System (Figure 3) consists of two filters. The proximal filter consists of a nitinol frame designed to allow apposition within vessels measuring 9–15 mm in diameter and containing a polyurethane filter with 140 µm diameter pores. The frame is radiopaque and will expand to oppose and seal against the vessel wall when unsheathed. The proximal filter is attached to a 100 cm long catheter, and following insertion, the proprietary proximal filter is deployed in the brachiocephalic artery, followed by the delivery of a second filter to the left common carotid artery (Figure 4). The entire system can be delivered through a 6 Fr sheath introduced through either the brachial or radial artery of the right arm. The system is deployed immediately prior to passage of the TAVI delivery catheter through the aortic arch and into the native valve during the TAVI procedure, and is removed after removal of the TAVI delivery catheter [33].


Stroke following transcatheter aortic valve implantation. Is neuroprotection justified?

Dąbrowski M, Witkowski A - Postepy Kardiol Interwencyjnej (2013)

The Claret CE Pro™ System consists of a proximal filter which is fixed within a flexible nitinol frame. The frame is radiopaque and will expand to oppose and seal to the vessel wall when unsheathed. Following first filter expansion, the system enables the delivery of the distal filter to the left common carotid artery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927112&req=5

Figure 0004: The Claret CE Pro™ System consists of a proximal filter which is fixed within a flexible nitinol frame. The frame is radiopaque and will expand to oppose and seal to the vessel wall when unsheathed. Following first filter expansion, the system enables the delivery of the distal filter to the left common carotid artery
Mentions: The Claret System (Figure 3) consists of two filters. The proximal filter consists of a nitinol frame designed to allow apposition within vessels measuring 9–15 mm in diameter and containing a polyurethane filter with 140 µm diameter pores. The frame is radiopaque and will expand to oppose and seal against the vessel wall when unsheathed. The proximal filter is attached to a 100 cm long catheter, and following insertion, the proprietary proximal filter is deployed in the brachiocephalic artery, followed by the delivery of a second filter to the left common carotid artery (Figure 4). The entire system can be delivered through a 6 Fr sheath introduced through either the brachial or radial artery of the right arm. The system is deployed immediately prior to passage of the TAVI delivery catheter through the aortic arch and into the native valve during the TAVI procedure, and is removed after removal of the TAVI delivery catheter [33].

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus