在跨导管心脏干预过程中进行脑栓塞保护
Victor Alfonso Jimenez Diaz1,2, Samir R Kapadia3, Axel Linke4
1Cardiology Department, Hospital Álvaro Cunqueiro, University Hospital of Vigo, Vigo, Spain.
概括
大脑栓塞保护装置 (CEPD) 在跨导管大动脉置换 (TAVR) 期间捕获碎片,但尚未被证明对预防中风的优越性. 需要进一步的试验来评估TAVR和其他程序中的CEPD.
科学领域:
- 心血管医学 心血管医学
- 神经学 神经学
- 生物医学工程 生物医学工程
背景情况:
- 脑卒中是通过导管的大动脉置换术 (TAVR) 的重要并发症,约有3%的患者患上.
- 大脑栓塞保护装置 (CEPD) 在TAVR过程中捕获栓塞碎片,成像研究表明它们可以减少新的脑损伤.
研究的目的:
- 审查TAVR和其他跨导管程序中CEPD的理由,证据和未来指导方针.
- 突出了为CEPD采用量身定制试验和成本效益评估的需要.
主要方法:
- 对CEPD临床病理学数据和现有临床试验证据的审查.
- 对显示CEPD脑损伤减少的成像研究的分析.
- 讨论非TAVR跨导管干预中脑栓塞的新兴证据.
主要成果:
- 在SENTINEL CEPD的第一个随机试验中,它未能达到其主要终点,即减少周围手术性中风.
- 在大多数TAVR患者中,CEPD捕获了大量的栓塞碎片.
- 在TAVR患者中,新的脑病变很常见,CEPD可以减少其体积.
结论:
- 尽管捕获了碎片,但目前的CEPD在随机试验中并没有在预防TAVR相关中风方面表现出优越性.
- 针对各种CEPD设计和评估它们在非TAVR程序中的使用,需要量身定制的临床试验.
- 评估CEPD的成本效益对于全球采用至关重要.
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