Filterbasierte Neuroprotektion bei Transkatheter-Aortenklappenimplantation: Was haben wir bisher gelernt?

Brain protection for stroke prophylaxis during transcatheter aortic valve implantation (TAVI) using mechanical protection devices has gained in importance in recent years. Randomized studies investigating the filter-based Sentinel™ cerebral protection system (Sentinel-CPS) have shown that the device has a high safety profile and is effective in capturing embolic debris as well as in reducing cerebral ischemia in magnetic resonance imaging. At the forefront of the discussions on the routine use of the Sentinel-CPS are testing of treatment prerequisites and the optimal planning of the procedure in addition to safety and effectiveness. For preoperative evaluation the most important examination prior to Sentinel-CPS implantation is computed tomography (CT) of the aorta with complete visualization of the supra-aortic branches. Anatomical variants, vascular diameter, stenoses, calcifications and kinking of the access and filter target vessels have to be assessed. A recent all-comers analysis determining the percentage of patients potentially eligible for Sentinel-CPS showed formal contraindications for implantation in 38% of patients (n = 122/317). The most common reason for exclusion (28%) was that the vessel dimensions within the target landing zone of the left common carotid artery (<6.5 mm) were too small. As only one size of filter system is currently available, only two thirds of the patients would seem to be eligible for Sentinel-CPS implantation. In order to avoid periprocedural complications and a potential device failure, a standardized preoperative planning protocol should be implemented for the application of the Sentinel-CPS.