INTRODUCTIONTranscatheter aortic valve replacement (TAVR) is recommended in patients with symptomatic severe aortic valve stenosis (AS) and an elevated surgical risk , and is serving a growing proportion of patients . As with surgical aortic valve replacement TAVR comes with a 30‐day major stroke rate of approximately 2–5% . TAVR requires large bore catheter navigation through the arterial vasculature and the implantation of a bioprosthesis within a degenerated aortic valve, which may provoke intraprocedural tissue dislodgment. Indeed, transcranial Doppler, brain magnetic resonance imaging (MRI) and histopathology studies suggest cerebral embolization in the vast majority of TAVR procedures . Silent brain lesions and (micro‐) infarcts may not be trivial, as they are associated with neurocognitive deterioration .Dedicated deflecting and filter‐based devices were designed to reduce cerebral embolization. The DEFLECT‐III trial demonstrated fewer ischemic brain lesions and preserved neurocognition with the TriGuard deflector . The Sentinel transcatheter cerebral embolic protection (TCEP) device (Claret medical, Santa Rosa, CA) provides filters to the brachiocephalic trunk and the left common carotid artery and thus omits the left vertebral artery. Recent studies demonstrated debris capture in almost all patients undergoing TAVR with Sentinel TCEP . Three randomized trials compared brain‐MRIs several days after TAVR in
Catheterization and Cardiovascular Interventions – Wiley
Published: Jan 1, 2018
Keywords: ; ; ;
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