title: Histopathology of embolic debris captured during transcatheter aortic valve replacement.
abstract: BACKGROUND
  Recent transcatheter aortic valve replacement studies have raised concerns about adverse cerebrovascular events. The etiopathology of the embolized material is currently unknown.
  
  
  RESULTS
  A total of 40 patients underwent transcatheter aortic valve replacement with the use of a dual filter-based embolic protection device (Montage Dual Filter System, Claret Medical, Inc). Macroscopic material liberated during the transcatheter aortic valve replacement procedure was captured in the device filter baskets in 30 (75%) patients and sent for histopathologic analysis. The captured material varied in size from 0.15 to 4.0 mm. Amorphous calcified material (size, 0.55-1.8 mm) was identified in 5 patients (17%). In 8 patients (27%), the captured material (size, 0.25-4.0 mm) contained valve tissue composed of loose connective tissue (collagen and elastic fibers) with focal areas of myxoid stroma, with or without coverage by endothelial cells and intermixed with fibrin. In another 13 (43%) patients, collagenous tissue, which may represent elements of vessel wall and valvelike structures, was identified. In 9 patients (30%), thrombotic material was intermixed with neutrophils (size, 0.15-2.0 mm). Overall, thrombotic material was found in 52% of patients, and tissue fragments compatible with aortic valve leaflet or aortic wall origin were found in 52% (21/40) of patients.
  
  
  CONCLUSIONS
  Embolic debris traveling to the brain was captured in 75% of transcatheter aortic valve replacement procedures where a filter-based embolic protection device was used. The debris consisted of fibrin, or amorphous calcium and connective tissue derived most likely from either the native aortic valve leaflets or aortic wall.
authors: Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, 's Gravendijkwal 230, Rotterdam, The Netherlands. n.vanmieghem@erasmusmc.nl
authors: Nicolas M
authors: NM
authors: Van Mieghem
authors: Marguerite E I
authors: ME
authors: Schipper
authors: Elena
authors: E
authors: Ladich
authors: Elham
authors: E
authors: Faqiri
authors: Robert
authors: R
authors: van der Boon
authors: Abas
authors: A
authors: Randjgari
authors: Carl
authors: C
authors: Schultz
authors: Adriaan
authors: A
authors: Moelker
authors: Robert-Jan
authors: RJ
authors: van Geuns
authors: Fumiyuki
authors: F
authors: Otsuka
authors: Patrick W
authors: PW
authors: Serruys
authors: Renu
authors: R
authors: Virmani
authors: Peter P
authors: PP
authors: de Jaegere
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization; D017128:Embolectomy / Q000295:instrumentation / Q000379:methods*; D057505:Embolic Protection Devices; D004617:Embolism / Q000473:pathology* / Q000517:prevention & control; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D008297:Male; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
keywords: aortic valve; intracranial embolism