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Cerebral Embolic Protection Devices: Current State of the Art
Ankit Agrawal1, Toshiaki Isogai1, Shashank Shekhar1
1Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland, OH.
Insights
Transcatheter aortic valve replacement (TAVR) can cause cerebrovascular events. Cerebral embolic protection devices aim to reduce these risks by capturing or deflecting emboli during the procedure.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Transcatheter aortic valve replacement (TAVR) is a primary treatment for severe aortic stenosis, expanding to lower-risk patients.
- Cerebrovascular events are significant complications of TAVR, increasing morbidity and mortality.
- Embolic origin is the likely cause of neurological events, frequently occurring acutely post-TAVR.
Purpose of the Study:
- To review cerebral embolic protection devices used in TAVR.
- To discuss the rationale and clinical data supporting these devices.
Main Methods:
- Literature review of existing studies and device types.
- Analysis of clinical data on the efficacy of embolic protection devices.
Main Results:
- Cerebral embolic protection devices are designed to mitigate embolic events during TAVR.
- These devices may reduce the incidence of peri-procedural ischemic events.
- Potential exists to decrease new silent ischemic lesions associated with TAVR.
Conclusions:
- Cerebral embolic protection devices offer a strategy to reduce neurological complications after TAVR.
- Further clinical data supports the role of these devices in improving TAVR outcomes.
- The review explores various device systems and their clinical evidence base.
Abstract:
Transcatheter aortic valve replacement (TAVR) has become a first-line treatment for severe aortic stenosis with intermediate to high-risk population with its use increasingly expanding into younger and low-risk cohorts as well. Cerebrovascular events are one of the most serious consequential complications of TAVR, which increase morbidity and mortality. The most probable origin of such neurological events is embolic in nature and the majority occur in the acute phase after TAVR when embolic events are most frequent. Cerebral embolic protection devices have been designed to capture or deflect these emboli, reducing the risk of peri-procedural ischaemic events. They also carry the potential to diminish the burden of new silent ischemic lesions during TAVR. Our review explores different types of these device systems, their rationale, and the established clinical data.
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