A prospective randomized evaluation of the TriGuard (TM) HDH embolic DEFLECTion device during transcatheter aortic valve implantation: results fromthe DEFLECT III trial

作者：Lansky Alexandra J^*; Schofer Joachim; Tchetche Didier; Stella Pieter; Pietras Cody G; Parise Helen; Abrams Kevin; Forrest John K; Cleman Michael; Reinoehl Jochen; Cuisset Thomas; Blackman Daniel; Bolotin Gil; Spitzer Stefan; Kappert Utz; Gilard Martine; Modine Thomas; Hildick Smith David; Haude Michael; Margolis Pauliina; Brickman Adam M; Voros Szilard; Baumbach Andreas

来源：European Heart Journal, 2015, 36(31): 2070-2078.

DOI：10.1093/eurheartj/ehv191

• Neuroprotection
• Transcatheter aortic valve implantation
• Diffusion-weighted imaging
• Cerebral ischaemia
• Stroke prevention

Aims To evaluate the safety, efficacy, and performance of the TriGuard (TM) HDH Embolic Deflection Device (TriGuard) compared with no cerebral protection in patients undergoing transcatheter aortic valve implantation (TAVI).
Methods and results From February 2014 to March 2015, 85 subjects undergoing TAVI at 13 centres in Europe and Israelwere randomized to TriGuard protection vs. no protection. Subjects underwent neurologic and cognitive evaluation at baseline, pre-discharge and 30 days; cerebral diffusion-weighted magnetic resonance imaging was performed at 4 +/- 2 days post-procedure and at 30 days. Technical success, which included complete 3-vessel cerebral coverage, was achieved in 88.9% (40/45) of cases. The primary in-hospital procedural safety endpoint (death, stroke, life-threatening or disabling bleeding, stage2 or 3 acute kidney injury, or major vascular complications) occurred in 21.7% ofTriGuard and 30.8% of control subjects (P = 0.34). In the Per Treatment population (subjects with complete three-vessel cerebral coverage), TriGuard use was associated with greater freedom from new ischaemic brain lesions (26.9 vs. 11.5%), fewer new neurologic deficits detected by the National Institutes of Health Stroke Scale (3.1 vs. 15.4%), improved Montreal Cognitive Assessment (MoCA) scores, better performance on a delayed memory task (P = 0.028) at discharge, and a >2-fold increase in recovery of normal cognitive MoCA score >26) at 30 days.
Conclusion TriGuard cerebral protection during TAVI is safe and complete cerebral vessel coveragewas achieved in 89% of subjects. In this exploratory study, subjects undergoing protected TAVI had more freedom from ischaemic brain lesions, fewer neurologic deficits, and improved cognitive function in some domains at discharge and 30 days compared with controls.

• 出版日期2015-8-14