Histological Characteristics and Predictors of Debris Obtained from Cerebral Protection Device during Transcatheter Aortic Valve Replacement

Background: Periprocedural stroke is one of the most severe complications to occur during transcatheter aortic valve replacement. Capture of debris by devices that provide cerebral embolic protection may reduce this risk. The study aimed to describe and evaluate the debris captured by the Sentinel cerebral embolic protection device during transfemoral transcatheter aortic valve replacement with different valve types.

Methods: The filters of 112 consecutive patients suitable for the cerebral protection device were collected. Captured debris was analyzed by histopathology and histomorphometry. Patient demographic data, pre- and postoperative data, complications, and mortality during follow-up were assessed.

Results: One hundred and twelve patients (71 male, 63%) were included in this study. The mean patient age was 79 ± 6.27 years (range: 50–94). The debris capture rate was high, with material found in the filters in 96% of all patients. The amount and type of captured debris did not differ among the proximal (brachiocephalic trunk) or distal (left carotid artery) filter. Four prevalent types of debris were identified: endothelium/vascular wall (43%), fibrin/thrombus (30%), calcification (9%), and foreign material (2%) (Fig. 1). With the balloon-expandable valve, there were significantly more patients with large debris measuring >1 mm (p = 0.04). Predilatation (p = 0.04) was a risk factor for embolic debris.

Conclusion: A significant difference was observed in the size and number of captured debris among self- and balloon-expandable valves. The largest particles were observed in patients treated with a balloon-expandable valve. Because large particles embolize more often in patients with predilatation, preprocedural planning should consider this finding. Since most of debris found consisted of fibrin or thrombus formations, an adequately activated clotting time during intervention is paramount. Both cerebral arteries (brachiocephalic trunk, left carotid artery) should be protected the same.

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Artikel online veröffentlicht:
11. Februar 2025