A Novel Logistic Model for Predicting Risk Factors and Contribution of Cerebral Small Vessel Disease DOI Creative Commons
Xuhui Liu, Kaiqiang Xu,

Cheng Liang

et al.

Research Square (Research Square), Journal Year: 2023, Volume and Issue: unknown

Published: Dec. 28, 2023

Abstract Background: Cerebral small vessel disease (CSVD) results in pathological alterations the arteries or veins of brain, thereby significantly impairing brain functionality. This study aimed to examine causative factors and ultimately determined proportion each risk factor for CSVD by constructing a multivariate model based on stepwise regression. Methods: A total 164 hospitalized patients were involved this study. The period was from January 2022 March 2023.The analyzed presence magnetic resonance imaging (MRI). imaging, history, coagulation indices, renal function related CSVD, serum biochemistry Hcy analyzed. Results: included safety analysis set, 73 ( 44.5% ) cases with 91 55.5% no. patients, median age 66 49 - 86 years.. logistic showed that yes hypertension OR = 10.94%, 95% CI: 3.80% ~ 35.57%, P ＜0.001 ), HbA1c 3.05%, 1.54% 7.51%, 0.005 HCY 1.45%, 1.22% 1.82%, ＜ 0.001 CRP 2.21%, 1.25% 4.10%, 0.008 TG 3.80%, 1.62% 10.00%, 0.004 TC 1.90%, 1.17% 3.25%, 0.013 morbidity. marginal R-squared R 2 M 0.467. Among all determinants, weight 60.60% maximum, followed 27.84% ).The quasi-curves plotted using bootstrap method (999 times) good agreement between predictive actual observations. Conclusion: Hypertension, HbA1c, HCY, CRP, morbidity, controlling above indicators within reasonable range will help reduce incidence CSVD.

Language: Английский

Transcatheter Aortic Valve Replacement: Current Status and Future Indications DOI Open Access
Manish Vinayak, Pier Pasquale Leone, R.J. Tanner

et al.

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 13(2), P. 373 - 373

Published: Jan. 10, 2024

In the past two decades, transcatheter aortic valve replacement (TAVR) has transformed management of stenosis and become standard care regardless surgical risk levels. Advances in design across newer generations, improved imaging, greater operator expertise, technical enhancements have collectively contributed to increased safety a decline procedural complications over this timeframe. The application TAVR progressively expanded include younger patients with lower risks, who longer life expectancies. This article offers an up-to-date review latest innovations delivery systems, devices, its possible future indications.

Language: Английский

Citations

9
Cerebral embolic protection for stroke prevention during transcatheter aortic valve replacement DOI
Jawad Basit, Mushood Ahmed, George G. Kidess

et al.

Expert Review of Cardiovascular Therapy, Journal Year: 2024, Volume and Issue: 22(8), P. 409 - 420

Published: July 26, 2024

Introduction Cerebral Embolic Protection Device (CEPD) captures emboli during Transcatheter Aortic Valve Replacement (TAVR). With recently published pivotal trials and multiple cohort studies reporting new data, there is a need to re-calibrate available statistical evidence.

Language: Английский

Citations

4
Cerebral Embolic Protection by Geographic Region DOI

Raj Makkar,

Aakriti Gupta,

Thomas Waggoner

et al.

JAMA Cardiology, Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 29, 2024

Importance Transcatheter aortic valve replacement (TAVR) is an established treatment option for many patients with severe symptomatic stenosis; however, debris dislodged during the procedure can cause embolic stroke. The Sentinel cerebral protection (CEP) device approved capture and removal of material TAVR but its efficacy has been debated. Objective To explore regional differences in association CEP utilization stroke outcomes undergoing TAVR. Design, Setting, Participants This post hoc analysis a prospective, postmarket, randomized clinical trial evaluating performed or without took place at 51 hospitals US, Europe, Australia from February 2020 to January 2022. Patients stenosis treated transfemoral were included. Randomization was stratified according center, operative risk, intended type. excluded if left common carotid brachiocephalic artery had greater than 70% anatomy precluded placement device. Data this study analyzed August October 2024. Intervention CEP. Main Outcomes Measures primary end point rate all events hospital discharge 72 hours post-TAVR, whichever came first. Neurological examinations baseline postprocedure identify stroke, disabling other neurological outcomes. Results Stroke Protection With During Aortic Valve Replacement (PROTECTED TAVR) enrolled 3000 (1803 [60.1%] male; mean [SD] age, 78.9 [7.8] years): 1833 US cohort (TAVR alone: 919, CEP: 914) 1167 outside (OUS) 580, 587). younger, more predominantly male, lower prevalence atrial fibrillation, higher bicuspid valve, diabetes, peripheral vascular disease compared OUS cohort. In main trial, incidence within after before did not differ significantly between group control group, there no interaction by geographic region. analysis, exhibited 50% relative risk reduction overall 73% alone; effect on observed Conclusion Relevance PROTECTED could show that use significant periprocedural Although region, exploratory suggests trend toward These findings are hypothesis generating, further research needed determine patient characteristics procedural practices affect efficacy. Trial Registration ClinicalTrials.gov Identifier: NCT04149535

Language: Английский

Citations

4
Neuroprotection Devices in Cardiac Catheterization Laboratories: Does It Sufficiently Protect Our Patients? DOI Creative Commons
Clement Tan,

Mark Higgins,

Vaikunthan Thanabalasingam

et al.

Medicina, Journal Year: 2025, Volume and Issue: 61(2), P. 305 - 305

Published: Feb. 10, 2025

Stroke is a devastating complication of cardiovascular interventions. Intraprocedural stroke well-documented and feared risk cardiac percutaneous transcatheter procedures. If clinically significant strokes are absent, silent remain the next in line to pose large concerns related future cognitive decline, risk, overall increased morbidity mortality. Cerebral protection devices (CPD) developed overtime aim neutralize this through either capture-based filter or deflector mechanism. Many CPDs exist currently, each one unique, with varying degrees evidence. The adoption has allowed procedures be carried out patients high thromboembolic risks who may have historically been discommended. Though skewed towards certain procedures, body evidence still present across other This review will discuss clinical importance respective rates, updated surrounding CPDs, differing opinions types cost benefits, what lies ahead for within realm undertaken catheterization laboratories.

Language: Английский

Citations

0
Optimal antithrombotic therapy after transcatheter aortic valve replacement: a comprehensive review DOI Creative Commons
Thanh Van Nguyen, Myeong‐Ki Hong, Young-Guk Ko

et al.

Frontiers in Cardiovascular Medicine, Journal Year: 2025, Volume and Issue: 12

Published: March 10, 2025

Transcatheter aortic valve replacement (TAVR) has become a leading treatment for stenosis, but managing thromboembolic and bleeding risks post-procedure remains challenging. This review examines current evidence on antithrombotic therapy after TAVR. Subclinical leaflet thrombosis is observed in 10%–20% of patients, though its clinical significance uncertain. Clinical rare. Current guidelines favor single antiplatelet patients without indications long-term anticoagulation, as dual increases risk improving outcomes. For requiring monotherapy with direct oral anticoagulants or vitamin K antagonists recommended to minimize bleeding. Ongoing trials aim clarify optimal regimens strategies preventing subclinical thrombosis. Individualized based patient profiles likely needed improve the efficacy safety post-TAVR.

Language: Английский

Citations

0
Management of complications after valvular interventions DOI
Agam Bansal,

Rishi Puri,

James Yun

et al.

EuroIntervention, Journal Year: 2025, Volume and Issue: 21(8), P. e390 - e410

Published: April 1, 2025

Transcatheter valve interventions have transformed the outcomes of patients with valvular heart disease who are at high risk for surgery. With increasing utilisation and expansion transcatheter interventions, it is utmost importance to be familiar their potential complications subsequent management, especially given relative infrequency many these issues in contemporary practice. Herein, we present a state-of-the-art review article focusing on complications, prevention, treatment following aortic implantation, mitral edge-to-edge repair, replacement.

Language: Английский

Citations

0
Thoracic endovascular aortic repair with left subclavian artery revascularization for type B aortic dissection: Outcomes of fenestrated physician-modified stent-graft versus unibody single-branched stent-graft DOI
Xiaoye Li, Bing Xu, Weicheng Zhao

et al.

Annals of Vascular Surgery, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Language: Английский

Citations

0
Outcomes and Predictors of Stroke After Transcatheter Aortic Valve Replacement in the Cerebral Protection Device Era DOI Creative Commons
Shashank Shekhar, Toshiaki Isogai, Ankit Agrawal

et al.

Journal of the American Heart Association, Journal Year: 2024, Volume and Issue: 13(15)

Published: Aug. 5, 2024

Studies have shown inconclusive results on the effectiveness of cerebral protection devices (CPDs) with transcatheter aortic valve replacement. We aimed to analyze national statistics stroke and other outcomes CPD use.

Language: Английский

Citations

1
Early Outcomes With Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation DOI Creative Commons
Shashank Shekhar, Amar Krishnaswamy, Grant W. Reed

et al.

Structural Heart, Journal Year: 2024, Volume and Issue: 9(1), P. 100353 - 100353

Published: Sept. 2, 2024

Highlights•Stroke remains a formidable cause of morbidity, mortality, and resource utilization in transcatheter aortic valve replacement (TAVR) patients.•Sentinel cerebral embolic protection device (CPD) is designed to capture remove debris thereby reducing the risk stroke.•There an interest identifying patients who may benefit from use CPD.•Patients with atrial fibrillation undergoing TAVR CPD had lower overall stroke, major stroke.•Thirty-day all readmissions were use.•Future studies other registries clinical trials are required corroborate our findings identify candidates for use.AbstractBackgroundLimited available which aim patient populations that would potentially devices (CPDs) during (TAVR). We aimed analyze impact among (AF).MethodsData on adult concomitant diagnosis AF was obtained 2017-2020 National Readmissions Database. Stroke, in-hospital 30-day readmission rates compared between no-CPD cohorts propensity score matched analysis. Association adverse events analyzed using multivariable logistic regression models.ResultsOf 100,928 eligible AF, used 6.9% mean age 80 years. independently associated stroke (1.7% vs. 2.2%; odds ratio [OR] 0.81 [95% CI 0.68-0.98]; p = 0.032), (1.2% 1.8%; OR 0.69 [0.55-0.86]; 0.001), mortality (0.9 1.5%; 0.56 [0.43-0.72]; < (12.7% 14.7%; 0.87 [0.81-0.94]; 0.001). Reduction noted high-volume but not low-volume centers.ConclusionsThe present point towards clear benefits TAVR. In anatomically patients, potential be considered especially as younger become Data future further findings.

Language: Английский

Citations

1
A Comprehensive Review of Percutaneous and Surgical Left Atrial Appendage Occlusion DOI Creative Commons
Michał Święczkowski, Emil Julian Dąbrowski, Paweł Muszyński

et al.

Journal of Cardiovascular Development and Disease, Journal Year: 2024, Volume and Issue: 11(8), P. 234 - 234

Published: July 27, 2024

Atrial fibrillation (AF) is the most common arrhythmia worldwide, and associated with a significant risk of thromboembolic events. Left atrial appendage occlusion (LAAO) has emerged as promising alternative for patients contraindications or intolerance to anticoagulant therapy. This review summarises current evidence, indications, technical advancements in surgical percutaneous LAAO. Preprocedural planning relies on various imaging techniques, each unique advantages limitations. The existing randomised clinical trials meta-analyses demonstrate favourable results both Postprocedural management emphasises personalised anticoagulation strategies comprehensive surveillance ensure device stability detect complications. Future focus should be put antithrombotic regimens, investigating predictors device-related complications, simplifying procedural aspects enhance patient outcomes. In summary, LAAO presented valuable therapeutic option preventing AF-related events, ongoing research aimed at refining techniques improving care.

Language: Английский

Citations

0