Embrella embolic deflection device for cerebral protection during transcatheter aortic valve replacement

Mariam Samim, Pierfrancesco Agostoni, Jeroen Hendrikse, Ricardo P J Budde, Freek Nijhoff, Jolanda Kluin, Faiz Ramjankhan, Pieter A. Doevendans, Pieter R. Stella*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)


AIMS: To compare the extent of cerebral ischemic injury after transcatheter aortic valve replacement (TAVR) with the use of an Embrella Embolic Deflector System versus unprotected TAVR.

METHODS: Fifteen patients with severe symptomatic aortic stenosis underwent TAVR with use of the Embrella Embolic Deflector System for cerebral protection. Cerebral diffusion-weighted magnetic resonance imaging (DWI) was performed in all patients at day 4 after the procedure and images were retrospectively compared to 37 patients who had previously undergone TAVR without a protection device (TAVR-only group).

RESULTS: Successful placement of the Embrella device was achieved in all patients. DWI revealed an increase in the number of ischemic lesions in the Embrella group compared with the TAVR-only group (9.0 vs 5.0, P = .044). The use of the Embrella device was however associated with a significant reduction in single-lesion volume: 9.7 μL [5.8, 18.4] versus 17.8 μL [9.5, 38.7] (P < .001). Moreover, total infarct volumes of more than 1000 μL were only seen in the TAVR-only group. More lesions occurred in the right side of the brain in the Embrella group, whereas in the TAVR-only group lesions were distributed equally between left and right. One patient in the TAVR-only group suffered from a transient ischemic attack. Postoperative evaluation was clinically uneventful in the Embrella group.

CONCLUSIONS: The use of the Embrella device during TAVR increased the number of cerebral ischemic lesions on postprocedural brain imaging. This increase in number was however accompanied by a significant reduction in single-lesion volume and the absence of large total infarct volumes.

Original languageEnglish
Pages (from-to)799-805.e2
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number3
Publication statusPublished - 1 Jan 2015


  • aortic valve stenosis
  • cerebral embolic protection device
  • cerebral ischemic injury
  • Embrella Embolic Deflector System
  • intracranial embolism
  • transcatheter aortic valve replacement


Dive into the research topics of 'Embrella embolic deflection device for cerebral protection during transcatheter aortic valve replacement'. Together they form a unique fingerprint.

Cite this