The use of a cerebral embolic protection device during transcatheter aortic valve implantation (TAVI) system is feasible and safe, a study published in EuroIntervention has shown. The first-in-man experience with the Claret Pro cerebral protection device was reported by Christoph K Naber, Contilia Heart and Vascular Center, Elisabeth Krankenhaus Essen, Essen, Germany, and Alexander Ghanem, Department of Medicine/Cardiology, University of Bonn, Bonn, Germany.
“One current challenge of TAVI is the reduction of procedural stroke. Procedural mobilisation of debris is a known source of cerebral embolisation. Mechanical protection by transient filtration of cerebral blood flow might reduce the embolic burden during TAVI. We aimed to evaluate the feasibility and safety of the Claret CE Pro cerebral protection device in patients undergoing TAVI,” the authors wrote.
Patients scheduled for TAVI were prospectively enrolled at three centres (Essen, Bonn and Sao Paulo, Brazil). The Claret CE Pro (Claret Medical) cerebral protection device was placed via the right radial/brachial artery prior to TAVI and was removed after the procedure. The primary endpoint was technical success rate. Secondary endpoints encompassed procedural and 30-day stroke rates, as well as device-related complications.
Deployment of the Claret CE Pro cerebral protection device was intended for use in 40 patients, 35 devices were implanted into the aortic arch. Technical success rate with delivery of the proximal and distal filter was 60% for the first generation device and 87% for the second-generation device. Delivery times for the first-generation device were 12.4±12.1 minutes and 4.4±2.5 minutes for the second-generation device (p<0.05). The quantity of contrast used related to the Claret CE Pro System was 19.6±3.8ml. Captured debris was documented in at least 19 of 35 implanted devices (54.3%). No procedural transient ischaemic attacks, minor strokes or major strokes occurred. Thirty-day follow-up showed one minor stroke occurring 30 days after the procedure, and two major strokes both occurring well after the patient had completed TAVI.
The authors wrote that capture of debris “in more than half of the patients provides evidence for the potential to reduce the procedural cerebral embolic burden utilising this dedicated filter system during TAVI.”