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Jagielak, Dariusz; Targonski, Radoslaw; Frerker, Christian; Abdel-Wahab, Mohamed; Wilde, Johannes; Werner, Nikos; Lauterbach, Michael; Leick, Juergen; Grygier, Marek; Misterski, Marcin; Erglis, Andrejs; Narbute, Inga; Witkowski, Adam Ryszard; Adam, Matti; Frank, Derk; Gatto, Fernando; Schmidt, Tobias; Lansky, Alexandra J
EuroIntervention, 09/2022, Volume: 18, Issue: 7Journal Article
Stroke remains a feared complication associated with transcatheter aortic valve implantation (TAVI). Embolic cerebral injury occurs in the majority of TAVI cases and can lead to cognitive dysfunction. The PROTEMBO C Trial evaluated the safety and performance of the ProtEmbo Cerebral Protection System in TAVI patients. Forty-one patients were enrolled in this single-arm study conducted at 8 European centres. The primary safety endpoint was the rate of VARC 2-defined major adverse cardiac and cerebrovascular events (MACCE) at 30 days; the primary performance endpoint was the composite rate of technical success versus performance goals (PG). Secondary endpoints included brain diffusion-weighted magnetic resonance imaging (DW-MRI), new lesion volume, and the rate of death or all strokes compared to historical data. Thirty-seven of 41 enrolled patients underwent TAVI with the ProtEmbo device (intention-to-treat ITT population). Both primary endpoints were met. MACCE at 30 days was 8.1% (upper limit of the 95% confidence interval CI: 21.3% vs PG 25%; p=0.009), and technical success was 94.6% (lower limit of the 95% CI: 82.3% vs PG 75%; p=0.003). New DW-MRI lesion volumes with ProtEmbo were smaller than in historical data, and 87% of patients completing MRI follow-up had no single lesion >150 mm . There was 1 stroke in a patient in whom the device was removed prematurely before TAVI completion. The PROTEMBO C Trial met its primary safety and performance endpoints compared to prespecified historical PGs. Patients had smaller brain lesion volumes on DW-MRI compared to prior series and no larger single lesions. These results warrant further evaluation of the ProtEmbo in a larger randomised controlled trial (RCT).
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