Histopathology of Embolic Debris Captured During Transcatheter Aortic Valve Replacement

• DOI: 10.1161/circulationaha.112.001091
• Publication Date: 2013-05-08T05:06:36Z
• Authors: Nicolas M. Van Mi...; Marguerite E.I. S...; Elena Ladich; Elham Faqiri; Robert van der Boon; Abas Randjgari; Carl Schultz; Adriaan Moelker; Robert-Jan van Geuns; Fumiyuki Otsuka; Patrick W. Serruys; Renu Virmani; Peter P. de Jaegere
• Keywords: Valve replacement

Recent transcatheter aortic valve replacement studies have raised concerns about adverse cerebrovascular events. The etiopathology of the embolized material is currently unknown.A total 40 patients underwent with use a dual filter-based embolic protection device (Montage Dual Filter System, Claret Medical, Inc). Macroscopic liberated during procedure was captured in filter baskets 30 (75%) and sent for histopathologic analysis. varied size from 0.15 to 4.0 mm. Amorphous calcified (size, 0.55-1.8 mm) identified 5 (17%). In 8 (27%), 0.25-4.0 contained tissue composed loose connective (collagen elastic fibers) focal areas myxoid stroma, or without coverage by endothelial cells intermixed fibrin. another 13 (43%) patients, collagenous tissue, which may represent elements vessel wall valvelike structures, identified. 9 (30%), thrombotic neutrophils 0.15-2.0 mm). Overall, found 52% fragments compatible leaflet origin were (21/40) patients.Embolic debris traveling brain 75% procedures where used. consisted fibrin, amorphous calcium derived most likely either native leaflets wall.