Objectives: The dual-filter cerebral embolic protection (CEP) device is increasingly used during
transcatheter aortic valve replacement (TAVR). However, complex vascular anatomy may
challenge CEP deployment. We aimed to analyze the impact of anatomical characteristics
on technical device failure during CEP application.
Methods: We retrospectively analyzed the multislice computed tomography scans (MSCT) of all
patients undergoing TAVR with dual-filter CEP between 2016 and 2020 (n = 92). The analysis included the assessment of aortic arch anatomy and the angles
of the supra-aortic arteries. Brachiocephalic and left common carotid artery tortuosity
index was determined by calculating a distance factor: ([(center-line distance)/(straight-line
distance) −1] × 100). Right subclavian tortuosity index was defined as the sum of
all tortuosity angles along its course. MSCT data was assessed for statistical significance
among TAVR patients with success of CEP deployment and among patients with technical
device failure.
Result: Procedural success of dual-filter CEP application was obtained in 83 patients (90.2%).
Technical device failure in 9 patients (9.8%) was due to the infeasibility to perform
correct deployment of both filters (n = 7) and to obtain peripheral radial access (2). Patients with a technical failure
of CEP application had a higher right subclavian tortuosity index (217 [92–324] vs.
150 [42–252], p = 0.046), a higher brachiocephalic tortuosity index (27 [5–51] vs. 10 [0–102], p = 0.033) and a larger angulation of the brachiocephalic artery (59 [22–80] vs. 39 degrees
[7–104], p = 0.014) compared with patients with successful CEP deployment. By receiver operating
curve analysis, a brachiocephalic angle greater than 59 degrees and a brachiocephalic
tortuosity index greater than 26 were identified as predictors for technical device
failure. No differences in aortic arch anatomy or common carotid artery tortuosity
were detected between the groups.
Conclusion: Brachiocephalic tortuosity was found to be associated with technical device failure
of dual-filter CEP application. Standardized preoperative calculation of index and
angulation might help to anticipate possible difficulties during CEP deployment.
