Explore the Risks and Rewards of Cerebral Embolic Protection

Samir Kapadia, M.D., Director, Catheterization Laboratory, Cleveland Clinic

Throughout Dr. Samir Kapadia’s career, he’s performed over 1,000 Transcatheter Aortic Valve Replacements. The director of the Catheterization Laboratory at the Cleveland Clinic in Cleveland, Ohio, weighs in on the procedure and encourages patients to consider cerebral embolic protection.

What is my risk of stroke during a Transcatheter Aortic Valve Replacement (TAVR) procedure, and how could cerebral embolic protection potentially reduce that risk?

The risk of stroke from TAVR is an ongoing, significant concern. The evidence shows it is as high as 3.5 percent, and clinically silent brain infarctions, as seen on MRI, occur in as many as 80 percent of patients and are associated with neurocognitive function changes. The FDA-cleared Sentinel device was designed to address the concern of peri-procedural stroke after TAVR, specifically those strokes related to embolic debris that is dislodged during valve replacement. Robust clinical evidence demonstrates that peri-procedural stroke rate was reduced by 63 percent when Sentinel was used during TAVR.

What is the patient’s reaction when you explain the benefit of cerebral embolic protection?

It’s a very positive reaction. More and more patients are asking for Sentinel during heart valve replacement procedures. We want to give them every protection we can. There’s an additional level of confidence that comes from knowing the efficacy and extra safety layer cerebral embolic protection provides during the TAVR procedure. Importantly, the device is extremely safe and easy to use. Sentinel protects the patients’ brains from potential harmful debris that can come loose during TAVR and block the flow of blood to the brain.

Would you recommend cerebral embolic protection to a family member?

Absolutely. Patients can benefit from having cerebral protection when undergoing TAVR procedures, since clinical data shows that 99 percent of patients generate debris during the TAVR procedure.

New technologies are changing the world of stroke prevention, treatment and recovery. Wearables can now measure almost every physical function and alert us when we might be at increased risk of stroke. Miniature (endovascular) devices can be inserted into our veins to safely remove blood clots from our brain and improve our prospects of recovery. Virtual reality programs have gamified physical rehab to encourage us to push our limits after stroke. The outlook in the United States has perhaps never been better. “But,” says World Stroke Organization (WSO) president and world-leading neurologist Professor Werner Hacke of Heidelberg, Germany, “ask any stroke survivor or family members what their most important stroke recovery tools are, and their answers are likely to be a lot more human than they are high-tech.”

Through comprehensive consultations, workshops and surveys, the WSO, an organization representing over 55,000 stroke experts worldwide, has gathered a global picture of what matters most to when it comes to rebuilding your life after stroke. Three words come up again and again: Hope. Connection. Motivation.

The Global Stroke Bill of Rights, a document developed by WSO members around the world, sets out what stroke survivors and caregivers might mean when they use these three powerful words:

1. Hope

To be provided with hope for the best possible recovery I can make, now and into the future.

2. Emotional support

To receive psychological and emotional support in a form that best meets my needs.

3. Inclusion

To be included in all aspects of society regardless of any disability I may have.

4. Long-term care

To receive support (financial or otherwise) to ensure that I am cared for in the longer-term.

5. Smooth transitions

To be supported to return to work and other activities.

6. Access

To get access to informal and formal advocacy to help me access the services I need.

7. Community

To be connected to other stroke survivors and caregivers so I may gain and provide support in my recovery from stroke.

From Stroke Awareness Month in May through to World Stroke Day on October 29, WSO will be calling for policy-makers and community service providers to focus on these long-term needs of survivors and families. “Given the pace of technological development,” says Professor Hacke, “the campaign will of course also look at the role that technology can play in stroke recovery. But the heart of our campaign this year will be the power of three little words to help people have the best possible life after stroke.”