Jobanputra Yash, Jones Brandon M, Mohananey Divyanshu, Fatima Benish, Kandregula Krishna, Kapadia Samir R
a Department of Cardiovascular Medicine , Heart and Vascular Institute, Cleveland Clinic , Cleveland , OH , USA.
Expert Rev Med Devices. 2017 Jul;14(7):529-543. doi: 10.1080/17434440.2017.1347038. Epub 2017 Jul 13.
Stroke is a devastating, potential complication of any cardiovascular procedure including transcatheter aortic valve implantation (TAVI). Even clinically silent lesions as detected by magnetic resonance imaging have been associated with poor long-term cognitive outcomes. As a result, extensive efforts have been focused on developing stroke preventative strategies including the development of novel embolic protection devices. These devices aim to reduce this risk by capturing or deflecting emboli away from the cerebral circulation. Areas covered: This review provides an insight into the incidence and mechanisms of neurologic events during TAVI, explores the design features and initial human experience of each of the cerebral embolic protection devices that have been used during TAVI, and carefully explains the major clinical trials of each of these devices with a focus on safety, efficacy and other reported outcomes. Expert commentary: The potential benefit of neuroprotection cannot be ignored as TAVI widens its scope to include younger and lower-risk patients wherein preventing a procedure related cerebral injury would potentially prevent long-term morbidity and mortality.
中风是包括经导管主动脉瓣植入术（TAVI）在内的任何心血管手术的一种严重的潜在并发症。即使是磁共振成像检测到的临床无症状病变也与长期认知不良后果相关。因此，大量努力集中在制定中风预防策略，包括开发新型栓塞保护装置。这些装置旨在通过捕获或使栓子偏离脑循环来降低这种风险。涵盖领域：本综述深入探讨了TAVI期间神经事件的发生率和机制，探讨了TAVI期间使用的每种脑栓塞保护装置的设计特点和初步人体经验，并详细解释了这些装置各自的主要临床试验，重点关注安全性、有效性和其他报告结果。专家评论：随着TAVI扩大其适用范围，纳入更年轻和风险更低的患者，神经保护的潜在益处不容忽视，在这些患者中预防与手术相关的脑损伤可能会预防长期发病和死亡。
