Interventions for valvular disease and heart failure

Heterogeneity of debris captured by cerebral embolic protection filters during TAVI

EuroIntervention 2021;16:1141-1147. DOI: 10.4244/EIJ-D-20-00744

Herbert Kroon
Herbert Kroon1, MD; Jan H. von der Thusen2, MD, PhD; Francesca Ziviello1, MD; Maarten van Wiechen1, MD; Joris F.W. Ooms1, MD; Isabella Kardys1, MD, PhD; Marguerite Schipper2, MD, PhD; Lennart van Gils1, MD, PhD; Joost Daemen1, MD, PhD; Peter de Jaegere1, MD, PhD; Nicolas M. Van Mieghem1, MD, PhD
1. Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; 2. Department of Pathology, Erasmus Medical Center, Rotterdam, the Netherlands

Aims: The aim of this study was to investigate the total amount, size and heterogeneity of debris captured among different transcatheter valve types and while repositioning.

Methods and results: A total of 328 patients who underwent transcatheter aortic valve implantation (TAVI) with the SENTINEL cerebral embolic protection (CEP) at our centre were eligible. Histopathological and semiquantitative analysis of captured debris was performed and data were entered into our prospective database. TAVI was performed with either the Evolut R/PRO (N=123), SAPIEN 3 (N=113) or Lotus valve (N=92). Capture of debris occurred in 98% of patients. Lotus TAVI resulted in more frequent foreign body material (62% vs 40% vs 47%, p=0.006), endothelium (49% vs 30% vs 16%, p<0.0005), calcified material (33% vs 12% vs 24%, p=0.001) and myocardial tissue (19% vs 11% vs 2%, p<0.0005) compared to SAPIEN 3 or Evolut R/PRO. Native (functional) bicuspid valves (OR 2.91, 95% CI: 1.20-7.03, p=0.02) and Lotus (OR 2.44, 95% CI: 1.14-5.24, p=0.02) were associated with the highest risk for dislodging particles ≥1,000 um. Valve repositioning was independently associated with larger amounts of debris (OR 2.96, 95% CI: 1.42-6.16, p=0.004).

Conclusions: All THV platforms had similar amounts of captured debris. THV repositioning seemed to be associated with a higher risk for dislodging greater amounts of debris to the brain.

Visual summary. Aetiopathology of debris captured by cerebral embolic protection filters during TAVI, including risk factors for greater amounts or larger particles of debris.

Sign in to read and download the full article

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from

aortic stenosiscerebral protectionischaemic stroketavi
Interventions for valvular diseaseInterventions for strokeTAVIIschaemic stroke
Read next article
Intravascular ultrasound assessment of coronary ostia following valve-in-valve transcatheter aortic valve implantation

Latest news