Study Evaluates Filter-Based Cerebral Protection During MitraClip Implantation

January 28, 2016—A study sought to assess the feasibility and safety of using a filter-based cerebral protection system (CPS) during MitraClip (Abbott Vascular) implantation and reported on the histopathologic analysis of the captured debris. The findings from the initial experience at two centers were published by Christian Frerker, MD, et al in the Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2016;9:171–179).

The investigators concluded that in this small study of patients undergoing MitraClip treatment with cerebral protection, embolic debris potentially conducive to cerebrovascular events was found in all patients. Debris was composed most often of acute thrombus, foreign material likely originating from the hydrophilic device coating, and valve/atrial wall tissue. They advised that further studies are warranted to assess the impact of cerebral protection on the incidence of cerebrovascular events after MitraClip therapy.

As summarized in JACC: Cardiovascular Interventions, 14 surgical high-risk patients (age 75 ± 7 years; seven men; median logistic EuroSCORE 21%) underwent MitraClip implantation employing cerebral protection with a dual embolic filter system between July 2014 and March 2015. All patients had severe mitral regurgitation of predominantly functional origin. All procedures were successfully completed for both CPS deployment/retrieval and MitraClip implantation. A total of 28 filters (two from each patient) were analyzed.

The investigators reported that debris was microscopically identified in all 14 patients, and the most common tissue types were acute thrombus and small fragments of foreign material, which were found in 12 patients (85.7%) each. Organizing thrombus was present in four patients (28.6%). Valve tissue and/or superficial atrial wall tissue was present in nine patients (64.3%), and fragments of myocardium were present in two patients (14.3%). No transient ischemic attacks, strokes, or deaths occurred periprocedurally or during a median follow-up interval of 8.4 months, stated the investigators in JACC: Cardiovascular Interventions.