Complete filter-based cerebral embolic protection with transcatheter aortic valve replacement

Area of Science:

• Cardiovascular Surgery
• Neurology
• Biomedical Engineering

Background:

• Cerebrovascular events post-transcatheter aortic valve replacement (TAVR) are a concern, especially for younger patients.
• Transcatheter cerebral embolic protection (TCEP) devices aim to prevent brain embolization during TAVR.
• Current TCEP devices protect three major arteries but leave the left vertebral artery vulnerable.

Purpose of the Study:

• To assess the efficacy of adding left vertebral artery filter protection to existing TCEP during TAVR.
• To evaluate the potential for complete cerebral protection against embolic events.

Main Methods:

• Patients undergoing TAVR received comprehensive TCEP, including a dual-filter system and an additional left vertebral artery filter.
• Filters were retrieved post-TAVR for histopathological analysis of captured embolic material.
• Deployment success rates for the left vertebral artery filter were recorded.

Main Results:

• Nine out of eleven patients had successful deployment of the left vertebral artery filter.
• No periprocedural strokes were observed in the study cohort.
• Embolic debris, including thrombus and foreign material, was found in all retrieved filters, with similar amounts in the left vertebral filter compared to standard filters.

Conclusions:

• The left vertebral artery serves as a significant pathway for emboli during TAVR.
• Selective filter protection of this artery successfully captured embolic debris in all evaluated patients.
• Further research is needed to establish the clinical benefit of complete filter-based TCEP in TAVR.