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. 2015 Aug 14;36(31):2070-2078.
doi: 10.1093/eurheartj/ehv191. Epub 2015 May 19.

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

Alexandra J Lansky  1 , Joachim Schofer  2 , Didier Tchetche  3 , Pieter Stella  4 , Cody G Pietras  5 , Helen Parise  5 , Kevin Abrams  6 , John K Forrest  7 , Michael Cleman  7 , Jochen Reinöhl  8 , Thomas Cuisset  9 , Daniel Blackman  10 , Gil Bolotin  11 , Stefan Spitzer  12 , Utz Kappert  13 , Martine Gilard  14 , Thomas Modine  15 , David Hildick-Smith  16 , Michael Haude  16 , Pauliina Margolis  17 , Adam M Brickman  18 , Szilard Voros  19 , Andreas Baumbach  20
Affiliations

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

Alexandra J Lansky et al. Eur Heart J. .

Abstract

Aims: To evaluate the safety, efficacy, and performance of the TriGuard™ 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 Israel were 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, stage 2 or 3 acute kidney injury, or major vascular complications) occurred in 21.7% of TriGuard 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 function (MoCA score >26) at 30 days.

Conclusion: TriGuard cerebral protection during TAVI is safe and complete cerebral vessel coverage was 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.

Keywords: Cerebral ischaemia; Diffusion-weighted imaging; Neuroprotection; Stroke prevention; Transcatheter aortic valve implantation.

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