Devices for continuous embolic protection

Cardiac embolism (CE) is a leading etiology of ischemic strokes and the cause of 25%-40% of cerebral infarctions worldwide. Cardioembolic strokes are associated with poor outcomes and relatively high recurrence rates, as compared to other causes of ischemic stroke. The leading causes of CE have not changed over the past decade but significant advances in primary treatment and stroke prevention methods have been achieved. This chapter reviews the latest updates in the field of permanent technologies for embolic stroke prevention and in particular CE. While prevention of cardioembolic stroke in patients with atrial fibrillation is mainly achieved by oral anticoagulants, this approach may be inappropriate for patients with extremely high bleeding risk or recent life-threatening bleeding. Therefore, device-based approaches for stroke prevention are being developed. Left atrial appendage closure devices have reached a clinical stage, while others are under evaluation. The experimental devices include the Diverter (MindGuard Ltd.), a permanent carotid coil filter (Javelin Ltd.), both implanted in carotid arteries. An aortic filtering device, SYNAXIS-XT was developed by InVatin Technologies, Ltd. These approaches and current challenges are reviewed in this chapter.