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Alexandra J. Lansky, Joachim Schofer, Didier Tchetche, Pieter Stella, Cody G. Pietras, Helen Parise, Kevin Abrams, John K. Forrest, Michael Cleman, Jochen Reinöhl, Thomas Cuisset, Daniel Blackman, Gil Bolotin, Stefan Spitzer, Utz Kappert, Martine Gilard, Thomas Modine, David Hildick-Smith, Michael Haude, Pauliina Margolis, Adam M. Brickman, Szilard Voros, Andreas Baumbach, A prospective randomized evaluation of the TriGuard™ HDH embolic DEFLECTion device during transcatheter aortic valve implantation: results from the DEFLECT III trial, European Heart Journal, Volume 36, Issue 31, 14 August 2015, Pages 2070–2078, https://doi.org/10.1093/eurheartj/ehv191
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Abstract
To evaluate the safety, efficacy, and performance of the TriGuard™ HDH Embolic Deflection Device (TriGuard) compared with no cerebral protection in patients undergoing transcatheter aortic valve implantation (TAVI).
From February 2014 to March 2015, 85 subjects undergoing TAVI at 13 centres in Europe and Israel were randomized to TriGuard protection vs. no protection. Subjects underwent neurologic and cognitive evaluation at baseline, pre-discharge and 30 days; cerebral diffusion-weighted magnetic resonance imaging was performed at 4 ± 2 days post-procedure and at 30 days. Technical success, which included complete 3-vessel cerebral coverage, was achieved in 88.9% (40/45) of cases. The primary in-hospital procedural safety endpoint (death, stroke, life-threatening or disabling bleeding, stage 2 or 3 acute kidney injury, or major vascular complications) occurred in 21.7% of TriGuard and 30.8% of control subjects (P = 0.34). In the Per Treatment population (subjects with complete three-vessel cerebral coverage), TriGuard use was associated with greater freedom from new ischaemic brain lesions (26.9 vs. 11.5%), fewer new neurologic deficits detected by the National Institutes of Health Stroke Scale (3.1 vs. 15.4%), improved Montreal Cognitive Assessment (MoCA) scores, better performance on a delayed memory task (P = 0.028) at discharge, and a >2-fold increase in recovery of normal cognitive function (MoCA score >26) at 30 days.
TriGuard cerebral protection during TAVI is safe and complete cerebral vessel coverage was achieved in 89% of subjects. In this exploratory study, subjects undergoing protected TAVI had more freedom from ischaemic brain lesions, fewer neurologic deficits, and improved cognitive function in some domains at discharge and 30 days compared with controls.
- ischemia
- hemorrhage
- cerebrovascular accident
- renal failure, acute
- methylenebis(chloroaniline)
- safety
- brain
- embolism
- brain lesions
- diffusion magnetic resonance imaging
- medical devices
- nih stroke scale
- cognitive ability
- montreal
- vascular complications
- neurologic deficits
- transcatheter aortic-valve implantation
- diffusion weighted magnetic resonance imaging
- maintenance of certification in anesthesiology