Cerebral embolic protection during transcatheter aortic valve replacement

doi:10.3969/j.issn.1672-6731.2024.01.008

Abstract

Abstract:

After more than 20 years of development, the complications of transcatheter aortic valve replacement (TAVR) have been significantly reduced, but the incidence of stroke has not been significantly reduced. In recent years, a variety of cerebral embolic protection device (CEPD) have been applied in clinical practice, but their effectiveness is still controversial due to the lack of high-quality clinical evidence. This article reviews progress on the risk factors for stroke and the characteristics of intraoperative CEPD in TAVR, so as to provide reference for the selection of TAVR cases and the formulation of cerebral embolic protection strategies.

Key words: Transcatheter aortic valve replacement, Embolic protection devices, Postoperative complications, Stroke, Review

摘要：

经导管主动脉瓣置换术经过20余年的发展，手术相关并发症已明显减少，唯术后脑卒中发生率无明显降低。近年多种脑保护装置应用于临床，但因缺乏高质量循环医学证据支持，其有效性尚存较大争议。本文综述经导管主动脉瓣置换术相关脑卒中危险因素以及术中脑保护装置的应用，为病例选择和脑保护策略制定提供参考。

关键词: 经导管主动脉瓣置换, 栓塞保护装置, 手术后并发症, 卒中, 综述

Shao-peng ZHANG, Yun-peng BAI, Nan JIANG. Cerebral embolic protection during transcatheter aortic valve replacement[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(1): 39-43.

张韶鹏, 白云鹏, 姜楠. 经导管主动脉瓣置换术中的脑保护[J]. 中国现代神经疾病杂志, 2024, 24(1): 39-43.

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References 34

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项目	Sentinel系统	TriGuard系统	Embrella系统	Emblok系统
生产公司	美国Boston Scientific公司	以色列Keystone Heart公司	美国Edwards Lifesciences公司	美国Innovative Cardiovascular Solutions公司
输送系统管径	6 F	8 ~ 9 F	6 F	11 F
动脉路径	桡动脉或肱动脉	股动脉	桡动脉或肱动脉	股动脉
滤网筛孔	140 μm	130 μm	100 μm	125 μm
原理	无名动脉和左颈总动脉内过滤或捕获栓子	将栓子分流，阻碍其进入无名动脉、左颈总动脉和左锁骨下动脉	将栓子分流，阻碍其进入主动脉弓上分支	完全封闭升主动脉，对主动脉弓上分支和降主动脉均有保护作用
缺点	左锁骨下动脉无保护	侵占股动脉路径，影响输送系统通过主动脉弓	贴附性较差，封闭不全，无法捕获栓子	压迫输送系统，无法保护冠状动脉
高质量临床试验	SENTINEL试验^[8]，PROTECTED-TAVR试验^[15]	REFLECT Ⅰ试验^[11]，REFLECT Ⅱ试验^[12]	PROTAVI-C试验^[13]	European Study Evaluating the Emblok Embolic Protection System During TAVR^[14]

项目	Sentinel系统	TriGuard系统	Embrella系统	Emblok系统
生产公司	美国Boston Scientific公司	以色列Keystone Heart公司	美国Edwards Lifesciences公司	美国Innovative Cardiovascular Solutions公司
输送系统管径	6 F	8 ~ 9 F	6 F	11 F
动脉路径	桡动脉或肱动脉	股动脉	桡动脉或肱动脉	股动脉
滤网筛孔	140 μm	130 μm	100 μm	125 μm
原理	无名动脉和左颈总动脉内过滤或捕获栓子	将栓子分流，阻碍其进入无名动脉、左颈总动脉和左锁骨下动脉	将栓子分流，阻碍其进入主动脉弓上分支	完全封闭升主动脉，对主动脉弓上分支和降主动脉均有保护作用
缺点	左锁骨下动脉无保护	侵占股动脉路径，影响输送系统通过主动脉弓	贴附性较差，封闭不全，无法捕获栓子	压迫输送系统，无法保护冠状动脉
高质量临床试验	SENTINEL试验^[8]，PROTECTED-TAVR试验^[15]	REFLECT Ⅰ试验^[11]，REFLECT Ⅱ试验^[12]	PROTAVI-C试验^[13]	European Study Evaluating the Emblok Embolic Protection System During TAVR^[14]

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