title: Histological Findings and Predictors of Cerebral Debris From Transcatheter Aortic Valve Replacement: The ALSTER Experience.
abstract: Histopathological analyses of debris captured by a cerebral protection system during transcatheter aortic valve replacement have been reported, but the origin of the captured debris was not determined and risk factors were not defined.
  
  
  
  Embolic debris was analyzed from 322 filters used in a dual-cerebral-filter protection system implemented during transcatheter aortic valve replacement for 161 patients (mean age 81 years, 82 male [51%], logistic EuroSCORE 19% [interquartile range 12-31%]). The debris capture rate was high, with debris from 97% of all patients (156 of 161). No differences by filter location were found (brachiocephalic trunk 86% [139 of 161], left carotid artery 91% [147 of 161]; adjusted P=0.999). Five prevalent types of debris were identified: thrombus (91%), arterial wall tissue (68%), valve tissue (53%), calcification (46%), and foreign material (30%). Female sex (P=0.0287, odds ratio 1.364, 95% CI 1.032-1.812) and diabetes mellitus (P=0.0116, odds ratio 1.474, 95% CI 1.089-2.001) were significant risk factors for embolic debris. Additional analysis showed significantly more valve tissue in patients with predilation (P=0.0294). Stroke and transient ischemic attack rates were 0.6% each (1 of 161).
  
  
  
  This study showed a high rate of embolic debris consisting of typical anatomic structures known to be altered in patients with aortic stenosis undergoing transcatheter aortic valve replacement. Female patients with diabetes mellitus have increased risk of embolic debris and should be protected by a cerebral protection system during transcatheter aortic valve replacement. Because valve tissue embolizes more often in patients with predilation, procedural planning should consider this finding. Both cerebral arteries (brachiocephalic trunk, left carotid artery) should be protected in the same way.
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany tob.schmidt@asklepios.com.
authors.forename: Tobias
authors.initials: T
authors.lastname: Schmidt
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Ozan
authors.initials: O
authors.lastname: Akdag
authors.affiliation: Asklepios Proresearch, Hamburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Wohlmuth
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Thielsen
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Dimitry
authors.initials: D
authors.lastname: Schewel
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Jury
authors.initials: J
authors.lastname: Schewel
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Hannes
authors.initials: H
authors.lastname: Alessandrini
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Kreidel
authors.affiliation: Department of Cardiothoracic Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Bader
authors.affiliation: CVPath Institute, Inc., Gaithersburg, MD.
authors.forename: Maria
authors.initials: M
authors.lastname: Romero
authors.affiliation: CVPath Institute, Inc., Gaithersburg, MD.
authors.forename: Elena
authors.initials: E
authors.lastname: Ladich
authors.affiliation: CVPath Institute, Inc., Gaithersburg, MD.
authors.forename: Renu
authors.initials: R
authors.lastname: Virmani
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schäfer
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Frerker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001158:Arteries; D016122:Brachiocephalic Trunk; D002114:Calcinosis; D002339:Carotid Arteries; D003920:Diabetes Mellitus / Q000453:epidemiology; D057505:Embolic Protection Devices; D004617:Embolism; D005260:Female; D005547:Foreign Bodies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012042:Registries; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology; D013927:Thrombosis; D065467:Transcatheter Aortic Valve Replacement
keywords: cerebrovascular disease/stroke; embolism; histopathology; transcatheter aortic valve implantation