Fighting Cardiac Thromboembolism during Transcatheter Procedures: An Update on the Use of Cerebral Protection Devices in Cath Labs and EP Labs
Alberto Preda,
Claudio Montalto,
Michele Galasso,
Andrea Munafò,
Ilaria Garofani,
Matteo Baroni,
Lorenzo Gigli,
Sara Vargiu,
Marisa Varrenti,
Giulia Colombo,
Marco Carbonaro,
Domenico Giovanni Della Rocca,
Jacopo Oreglia,
Patrizio Mazzone,
Fabrizio Guarracini
Affiliations
Alberto Preda
Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
Claudio Montalto
Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
Michele Galasso
Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
Andrea Munafò
Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
Ilaria Garofani
Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
Matteo Baroni
Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
Lorenzo Gigli
Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
Sara Vargiu
Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
Marisa Varrenti
Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
Giulia Colombo
Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
Marco Carbonaro
Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
Domenico Giovanni Della Rocca
Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1090 Brussels, Belgium
Jacopo Oreglia
Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
Patrizio Mazzone
Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
Fabrizio Guarracini
Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy
Intraprocedural stroke is a well-documented and feared potential risk of cardiovascular transcatheter procedures (TPs). Moreover, subclinical neurological events or covert central nervous system infarctions are concerns related to the development of dementia, future stroke, cognitive decline, and increased risk of mortality. Cerebral protection devices (CPDs) were developed to mitigate the risk of cardioembolic embolism during TPs. They are mechanical barriers designed to cover the ostium of the supra-aortic branches in the aortic arch, but newer devices are able to protect the descending aorta. CPDs have been mainly designed and tested to provide cerebral protection during transcatheter aortic valve replacement (TAVR), but their use in both Catheterization and Electrophysiology laboratories is rapidly increasing. CPDs have allowed us to perform procedures that were previously contraindicated due to high thromboembolic risk, such as in cases of intracardiac thrombosis identified at preprocedural assessment. However, several concerns related to their employment have to be defined. The selection of patients at high risk of thromboembolism is still a subjective choice of each center. The aim of this review is to update the evidence on the use of CPDs in either Cath labs or EP labs, providing an overview of their structural characteristics. Future perspectives focusing on their possible future employment are also discussed.