An embolic deflection device for aortic valve interventions

JACC Cardiovasc Interv. 2010 Nov;3(11):1133-8. doi: 10.1016/j.jcin.2010.05.022.


Objectives: We describe initial human experience with a novel cerebral embolic protection device.

Background: Cerebral emboli are the major cause of procedural stroke during percutaneous aortic valve interventions.

Methods: With right radial artery access, the embolic protection device is advanced into the aortic arch. Once deployed a porous membrane shields the brachiocephalic trunk and the left carotid artery deflecting emboli away from the cerebral circulation. Embolic material is not contained or removed by the device. The device was used in 4 patients (mean age 90 years) with severe aortic stenosis undergoing aortic balloon valvuloplasty (n = 1) or transcatheter aortic valve implantation (n = 3).

Results: Correct placement of the embolic protection device was achieved without difficulty in all patients. Continuous brachiocephalic and aortic pressure monitoring documented equal pressures without evidence of obstruction to cerebral perfusion. Additional procedural time due to the use of the device was 13 min (interquartile range: 12 to 16 min). There were no procedural complications. Pre-discharge cerebral magnetic resonance imaging found no new defects in any of 3 patients undergoing transcatheter aortic valve implantation and a new 5-mm acute cortical infarct in 1 asymptomatic patient after balloon valvuloplasty alone. No patient developed new neurological symptoms or clinical findings of stroke.

Conclusions: Embolic protection during transcatheter aortic valve intervention seems feasible and might have the potential to reduce the risk of cerebral embolism and stroke.

MeSH terms

  • Aged, 80 and over
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / therapy*
  • Blood Pressure
  • British Columbia
  • Cardiac Catheterization / adverse effects
  • Cardiac Catheterization / instrumentation*
  • Cardiac Catheterization / methods
  • Catheterization
  • Embolic Protection Devices*
  • Feasibility Studies
  • Female
  • Heart Valve Prosthesis Implantation / adverse effects
  • Heart Valve Prosthesis Implantation / instrumentation*
  • Heart Valve Prosthesis Implantation / methods
  • Humans
  • Intracranial Embolism / diagnosis
  • Intracranial Embolism / etiology
  • Intracranial Embolism / prevention & control*
  • Magnetic Resonance Imaging
  • Male
  • Prosthesis Design
  • Radial Artery
  • Radiography, Interventional
  • Stroke / etiology
  • Stroke / prevention & control
  • Time Factors
  • Treatment Outcome