Effectiveness of embolic protection filter devices in stroke prevention during endovascular aortic arch repair in significant aortic atheroma patients. (31st January 2019)

• Record Type: Journal Article
• Authors: Shimamura, Kazuo; Kuratani, Toru; Kin, Keiwa; Shijo, Takayuki; Masada, Kenta; Sawa, Yoshiki
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 28:Number 6(2019)
• Page Start: 974
• Page End: 980
• Publication Date: 2019-01-31
• Subjects: Hybrid aortic arch repair -- Filter protection -- Stroke; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivz004
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: OBJECTIVES: The objective of this study was to evaluate the effectiveness of embolic protection filter device in stroke prevention during hybrid endovascular arch repair in patients with significant aortic atheroma. METHODS: Twenty-two patients (20 men, mean age 79.0 years, mean logistic EuroSCORE 23.9%) with aortic arch/proximal descending aortic diseases and significant aortic atheroma (atheroma grade ≥ II) who were deemed unfit for conventional open surgery underwent endovascular aortic arch repair with protection of the supra-arch vessels using a balloon catheter and filter devices. The effectiveness in preventing stroke was evaluated by a postoperative neurological examination protocol, which was followed by neuroimaging with computed tomography/DW-magnetic resonance imaging (MRI) study in cases with neurological deficits. RESULTS: The atheroma grades of the aortic arch were II, III and IV in 36%, 14% and 50% of the patients, respectively. In total, 37 filter devices were placed in the supra-aortic vessels (5 brachiocephalic arteries, 23 carotid arteries, 5 subclavian arteries and 4 vertebral arteries). Technical success was achieved in all patients, and 30-day mortality was 4.5% (1/22 cases). Two (9.1%) cases showed neurological symptomatic stroke postoperatively. With DW-MRI examination, a major new region was detected in the filter-protected left carotid artery in one case and in the balloon-protected left vertebral artery in another case. CONCLUSIONS: In high-risk patients with significant aortic arch atheroma, hybrid endovascular aortic arch repair with embolic protection using a filter device showed satisfactory early results. Filter protection could be an attractive adjunct manoeuvre for preventing critical stroke during endovascular arch repair.