Efficacy of A Novel Antithrombogenic Coating for Cerebral Protection Devices

Background: There is a high rate of cerebral microemboli during invasive left-sided cardiac procedures. Cerebral protection may be useful to reduce risks. However, intravascular catheters may have risk for forming clot. We sought to evaluate effect of a novel antithrombogenic coating on clot formation on cerebral protection devices.

Method: Two different types of novel antithrombogenic coated filter materials (A- and S-coated) were evaluated in 3 canines and compared against uncoated devices. Brain MRIs prior to and after the procedure were done. Catheters were left in the left or right carotid arteries until occluded or for up to 4.5 hours. Antegrade cerebral blood flow was evaluated and clot occupation rate as a percentage of filter surface area was calculated.

Result: 4 non-coated, 3 A-coated, and 6 S-coated devices were evaluated. 3/4 non-coated catheters occluded over average 20 minutes (min) while one remained patent for 4.25 hours. 1/3 A-coated catheters occluded due to arterial spasm within 32 min while 2 remained patent over an average 3.5 hours. 3/6 S-coated catheters occluded after an average 29 mins while 3/6 remained patent over an average 4.1 hours. Average clot occupation was greater in non-coated (53+6%) than S-coated (38+11%) or A-coated (24+19%) catheters (p<0.05). No animals exhibited MRI evidence of microemboli on post-procedural MRIs.

Conclusion: Cerebral protection devices may be at risk of impeding antegrade flow due to clot deposition, arterial spasm, or mis-sizing. Clot deposition on filter material used for cerebral protection devices is a risk and novel antithrombogenic materials may reduce this risk.

Keywords:Stroke; Anticoagulation; Interventional cardiology; Microemboli; Thrombus