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Schlaganfallprophylaxe bei der Transkatheteraortenklappenimplantation (TAVI)

Aktueller Stand

Stroke prevention in transcatheter aortic valve implantation (TAVI)

Current situation

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Der Kardiologe Aims and scope

Zusammenfassung

Hintergrund

Die Transkatheteraortenklappenimplantation (TAVI) ist die Standardtherapie bei Patienten mit hochgradiger Aortenklappenstenose und hohem Operationsrisiko. Aktuelle Studien bestätigen diese guten Ergebnisse ebenso bei Patienten mit intermediärem Risiko. Eine gefürchtete Komplikation bleibt die zerebrale Embolie, die aufgrund der TAVI zu Schlaganfällen und irreversibler Hirnschädigung führen kann. Es sind verschiedene Protektionssysteme zur Schlaganfallprophylaxe erhältlich.

Fragestellung

Betrachtet wird die Reduktion von zerebralen Embolien bei TAVI durch zerebrale Protektionssysteme.

Material und Methoden

Es erfolgt die Auswertung aller verfügbaren Studien zu zerebralen Protektionssystemen.

Ergebnisse

Drei verschiedene zerebrale Protektionssysteme stehen aktuell zur Verfügung. Alle 3 Systeme sind sicher in ihrer Anwendung. Der Nutzen von zerebralen Protektionssystemen konnte auf subklinischer Ebene durch die Reduktion von Läsionsvolumen und Läsionsanzahl in zerebraler Bildgebung (insbesondere Magnetresonanztomographieuntersuchungen) gezeigt werden, aber auch auf klinischer Ebene gibt es Hinweise, dass eine zerebrale Protektion zu einer Reduktion von Mortalität und Schlaganfällen führen kann.

Schlussfolgerung

Zerebrale Protektionssysteme bei TAVI scheinen sicher zu sein und in der Lage, zerebrale Embolien zu verhindern.

Abstract

Background

Transcatheter aortic valve implantation (TAVI) is the standard of care for patients with high-grade aortic valve stenosis and a high-risk for surgery. Current studies confirm these favorable results for TAVI even for intermediate-risk patients. Although good procedural success and clinical outcomes have been shown complications, such as stroke with irreversible brain injury still remain. Various embolic protection devices to avert periprocedural stroke and brain injury are available.

Objective

Reduction of cerebral embolisms and stroke by the use of embolic protection devices.

Material and methods

An up to date literature search on cerebral protection systems was carried out and the results were evaluated.

Results

Currently, three different protection devices are commercially available in Germany. All devices have shown favorable safety profiles. The efficacy of cerebral protection devices could be shown at the subclinical level by a reduction of ischemic lesions and volumes in cerebral imaging, particularly with diffusion-weighted magnetic resonance imaging (DW-MRI). At the clinical level there is also evidence that cerebral protection can lead to a reduction of mortality and stroke during TAVI.

Conclusion

Cerebral protection devices during TAVI seem to be safe and in a position to prevent cerebral embolisms.

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Authors and Affiliations

  1. Abteilung für Kardiologie, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland

    T. Ubben, T. Schmidt, K.-H. Kuck &  C. Frerker

Authors
  1. T. Ubben
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  2. T. Schmidt
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  3. K.-H. Kuck
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  4. C. Frerker
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Corresponding author

Correspondence to C. Frerker.

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Interessenkonflikt

T. Ubben, K.-H. Kuck und C. Frerker geben an, dass kein Interessenkonflikt besteht. T. Schmidt erhielt Reiseunterstützung und Vortragshonorar von Claret Medical, Santa Rosa, CA, USA.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Ubben, T., Schmidt, T., Kuck, KH. et al. Schlaganfallprophylaxe bei der Transkatheteraortenklappenimplantation (TAVI). Kardiologe 11, 480–485 (2017). https://doi.org/10.1007/s12181-017-0191-8

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  • DOI: https://doi.org/10.1007/s12181-017-0191-8

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