Cerebral Embolic Protection in Patients Undergoing Left Atrial Appendage Closure
(1) Background: Cerebral magnetic resonance imaging has reported new cerebral ischemic lesions after left atrial appendage (LAA) closure in about one- third of patients. Stroke occurs predominantly periprocedurally. This study evaluated the characteristics of embolized debris captured by the SENTINE...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2024-12-01
|
| Series: | Journal of Cardiovascular Development and Disease |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2308-3425/12/1/5 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832588295640449024 |
|---|---|
| author | Julia Seeger Philipp Seppelt Mario Iturbe-Orbe David Leistner Jochen Wöhrle Michael Joner |
| author_facet | Julia Seeger Philipp Seppelt Mario Iturbe-Orbe David Leistner Jochen Wöhrle Michael Joner |
| author_sort | Julia Seeger |
| collection | DOAJ |
| description | (1) Background: Cerebral magnetic resonance imaging has reported new cerebral ischemic lesions after left atrial appendage (LAA) closure in about one- third of patients. Stroke occurs predominantly periprocedurally. This study evaluated the characteristics of embolized debris captured by the SENTINEL<sup>TM</sup> cerebral embolic protection system in patients undergoing LAA closure; (2) Methods: Sixty filters of 30 consecutive patients undergoing LAA closure with the WATCHMAN FLX<sup>TM</sup> device were collected and captured debris was analyzed by histopathology and histomorphometry. Clinical outcome measures were disabling and non-disabling stroke within 72 h; (3) Results: In most filters, no material was captured. The predominant captured debris was acute or organized thrombi. The most common pattern was acute fibrin-rich thrombus, which was detected in 11/30 (33.3%) patients. Particles of heart tissue were seen in 6/30 (20%) patients, and foreign material was seen in one (3.3%) patient. The number of particles ranged from 0 to 52 per patient with a maximum of 31 in the distal and 21 in the proximal filter. Particle diameter ranged from 131 to 2614 µm. By logistic regression analysis, only protected time remained a multivariable predictor for larger particles (<i>p</i> = 0.039). There was no disabling or non-disabling stroke. Compared to transfemoral aortic valve replacement, the number of particles is only about 1.5%. (4) Conclusion: LAA occlusion with the WATCHMAN FLX<sup>TM</sup> was associated with a very low number of embolized particles captured with the double-filter SENTINEL<sup>TM</sup> embolic protection system and no periprocedural stroke. |
| format | Article |
| id | doaj-art-a73235b2e1d3457b82860c95db4d07a6 |
| institution | Kabale University |
| issn | 2308-3425 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj-art-a73235b2e1d3457b82860c95db4d07a62025-01-24T13:35:56ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252024-12-01121510.3390/jcdd12010005Cerebral Embolic Protection in Patients Undergoing Left Atrial Appendage ClosureJulia Seeger0Philipp Seppelt1Mario Iturbe-Orbe2David Leistner3Jochen Wöhrle4Michael Joner5Department of Cardiology and Intensive Care, Medical Campus Lake Constance, 88048 Friedrichshafen, GermanyUniversitäres Herz- und Gefäßzentrum, Goethe University Frankfurt, 60590 Frankfurt am Main, GermanyDepartment of Cardiology and Intensive Care, Medical Campus Lake Constance, 88048 Friedrichshafen, GermanyUniversitäres Herz- und Gefäßzentrum, Goethe University Frankfurt, 60590 Frankfurt am Main, GermanyUniversity of Ulm, 89081 Ulm, GermanyGerman Heart Centre Munich, 80636 Munich, Germany(1) Background: Cerebral magnetic resonance imaging has reported new cerebral ischemic lesions after left atrial appendage (LAA) closure in about one- third of patients. Stroke occurs predominantly periprocedurally. This study evaluated the characteristics of embolized debris captured by the SENTINEL<sup>TM</sup> cerebral embolic protection system in patients undergoing LAA closure; (2) Methods: Sixty filters of 30 consecutive patients undergoing LAA closure with the WATCHMAN FLX<sup>TM</sup> device were collected and captured debris was analyzed by histopathology and histomorphometry. Clinical outcome measures were disabling and non-disabling stroke within 72 h; (3) Results: In most filters, no material was captured. The predominant captured debris was acute or organized thrombi. The most common pattern was acute fibrin-rich thrombus, which was detected in 11/30 (33.3%) patients. Particles of heart tissue were seen in 6/30 (20%) patients, and foreign material was seen in one (3.3%) patient. The number of particles ranged from 0 to 52 per patient with a maximum of 31 in the distal and 21 in the proximal filter. Particle diameter ranged from 131 to 2614 µm. By logistic regression analysis, only protected time remained a multivariable predictor for larger particles (<i>p</i> = 0.039). There was no disabling or non-disabling stroke. Compared to transfemoral aortic valve replacement, the number of particles is only about 1.5%. (4) Conclusion: LAA occlusion with the WATCHMAN FLX<sup>TM</sup> was associated with a very low number of embolized particles captured with the double-filter SENTINEL<sup>TM</sup> embolic protection system and no periprocedural stroke.https://www.mdpi.com/2308-3425/12/1/5cerebral embolic protectionstrokedebrisleft atrial appendage occluderWATCHMAN FLXSENTINEL |
| spellingShingle | Julia Seeger Philipp Seppelt Mario Iturbe-Orbe David Leistner Jochen Wöhrle Michael Joner Cerebral Embolic Protection in Patients Undergoing Left Atrial Appendage Closure Journal of Cardiovascular Development and Disease cerebral embolic protection stroke debris left atrial appendage occluder WATCHMAN FLX SENTINEL |
| title | Cerebral Embolic Protection in Patients Undergoing Left Atrial Appendage Closure |
| title_full | Cerebral Embolic Protection in Patients Undergoing Left Atrial Appendage Closure |
| title_fullStr | Cerebral Embolic Protection in Patients Undergoing Left Atrial Appendage Closure |
| title_full_unstemmed | Cerebral Embolic Protection in Patients Undergoing Left Atrial Appendage Closure |
| title_short | Cerebral Embolic Protection in Patients Undergoing Left Atrial Appendage Closure |
| title_sort | cerebral embolic protection in patients undergoing left atrial appendage closure |
| topic | cerebral embolic protection stroke debris left atrial appendage occluder WATCHMAN FLX SENTINEL |
| url | https://www.mdpi.com/2308-3425/12/1/5 |
| work_keys_str_mv | AT juliaseeger cerebralembolicprotectioninpatientsundergoingleftatrialappendageclosure AT philippseppelt cerebralembolicprotectioninpatientsundergoingleftatrialappendageclosure AT marioiturbeorbe cerebralembolicprotectioninpatientsundergoingleftatrialappendageclosure AT davidleistner cerebralembolicprotectioninpatientsundergoingleftatrialappendageclosure AT jochenwohrle cerebralembolicprotectioninpatientsundergoingleftatrialappendageclosure AT michaeljoner cerebralembolicprotectioninpatientsundergoingleftatrialappendageclosure |