Cerebral Protection in Transcatheter Aortic Valve Replacement
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ClinicalTrials.gov Identifier: NCT02214277 |
Recruitment Status :
Completed
First Posted : August 12, 2014
Results First Posted : May 11, 2018
Last Update Posted : May 11, 2018
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Condition or disease | Intervention/treatment | Phase |
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Severe Symptomatic Calcified Native Aortic Valve Stenosis | Device: Cerebral Protection System-The SENTINEL System with TAVR Device: TAVR | Not Applicable |
The Sentinel™ Cerebral Protection System is indicated for use as an embolic capture and retrieval system intended to reduce the ischemic burden in the cerebral anterior circulation while performing transcatheter aortic valve replacement.
The objective of this study is to assess the safety and efficacy of the Claret Medical Sentinel Cerebral Protection System used for embolic protection during Transcatheter Aortic Valve Replacement (TAVR) compared to TAVR standard of care (without embolic protection).
The study population is comprised of subjects with severe symptomatic calcified native aortic valve stenosis who meet the commercially approved indications for TAVR with the Edwards SAPIEN THV or SAPIEN XT and comply with the inclusion/exclusion criteria.
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 363 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | Double (Participant, Outcomes Assessor) |
Primary Purpose: | Prevention |
Official Title: | Cerebral Protection in Transcatheter Aortic Valve Replacement - The SENTINEL Study |
Study Start Date : | September 2014 |
Actual Primary Completion Date : | March 2016 |
Actual Study Completion Date : | June 2016 |

Arm | Intervention/treatment |
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Experimental: Test Arm |
Device: Cerebral Protection System-The SENTINEL System with TAVR
Claret Medical Sentinel Cerebral Protection System is intended for use as an embolic protection system to contain and remove embolic material (thrombus/debris) that may enter the carotid arteries.
Other Names:
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Active Comparator: Control Arm |
Device: TAVR
Other Name: TAVR: Edwards SAPIEN THV or Edwards SAPIEN XT |
Safety Arm |
Device: Cerebral Protection System-The SENTINEL System with TAVR
Claret Medical Sentinel Cerebral Protection System is intended for use as an embolic protection system to contain and remove embolic material (thrombus/debris) that may enter the carotid arteries.
Other Names:
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- Reduction in Median Total New Lesion Volume in Protected Territories Between Test and Control Arms as Assessed by DW-MRI at Day 2-7 Post-procedure. [ Time Frame: Day 2-7 Post-Procedure ]Total new lesion volume is defined as the sum of all diffusion-positive new cerebral lesions in post-TAVR DW-MRI relative to the pre-TAVR DW-MRI scans. Protected territories are defined as brain territories uniquely perfused by the vessels protected by the Sentinel System, namely the left and right carotid arteries, and the right vertebral artery.
- Patients With Major Adverse Cardiac and Cerebrovascular Events (MACCE) at 30 Days [ Time Frame: 30 Days Post-Procedure ]Primary Safety Endpoint: MACCE (all death, all stroke, and acute kidney injury class 3 within 72 hours or discharge, whatever occurs first) at 30 days compared to a historical performance goal of 18.3%.
- Captured Debris Histopathology (Observational) [ Time Frame: Post-procedure ]

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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
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Approved indications for commercially available Edwards SAPIEN Transcatheter Heart Valve, model 9000TFX or SAPIEN XT, model 9300TFX meeting one of the three sub-criteria below:
SAPIEN
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transfemoral delivery in subjects with severe symptomatic calcified native aortic valve stenosis without severe aortic insufficiency and with ejection fraction >20% who have been examined by a heart team including an experienced cardiac surgeon and a cardiologist and found to either be:
- inoperable and in whom existing co-morbidities would not preclude the expected benefit from correction of the aortic stenosis; or
- be operative candidates for aortic valve replacement but who have a Society of Thoracic Surgeons predicted operative risk score >8% or are judged by the heart team to be at a 15% risk of mortality for surgical aortic valve replacement.
or
-
transapical delivery in subjects with severe symptomatic calcified native aortic valve stenosis without severe aortic insufficiency and with ejection fraction > 20% who have been examined by a heart team including an experienced cardiac surgeon and a cardiologist and found to be operative candidates for aortic valve replacement but who have a Society of Thoracic Surgeons operative risk score 8% or are judged by the heart team to be at a 15% risk of mortality for surgical aortic valve replacement.
SAPIEN XT (Transfemoral or Transapical only)
- in patients with symptomatic heart disease due to severe native calcific aortic stenosis (aortic valve area ≤ 1.0 cm2 or aortic valve area index ≤ 0.6 cm2/m2, a mean aortic valve gradient of ≥ 40 mmHg, or a peak aortic-jet velocity of ≥ 4.0 m/s), and with native anatomy appropriate for the 23, 26, or 29 mm valve system, who are judged by a heart team, including a cardiac surgeon, to be at high or greater risk for open surgical therapy (i.e., Society of Thoracic Surgeons operative risk score ≥8% or at a ≥15% risk of mortality at 30 days).
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- Compatible left common carotid artery (6.5 - 10 mm) and brachiocephalic artery (9 - 15 mm) diameters without significant stenosis (> 70%) as determined by Multi-Slice Computed Tomography (MSCT) scan or equivalent imaging modality
- The subject and the treating physician agree that the subject will return for all required post-procedure follow-up visit
- The subject or the subject's legal representative has been informed of the nature of the trial, agrees to its provisions and has provided written informed consent as approved by the IRB of the respective clinical site
Exclusion Criteria:
General
- Vasculature in the right extremity precluding 6Fr sheath radial or brachial access
- Inadequate circulation to the right extremity as evidenced by signs of artery occlusion (modified Allen's test) or absence of radial/brachial pulse
- Hemodialysis shunt, graft, or arterio-venous fistula involving the upper extremity vasculature
- Evidence of an acute myocardial infarction ≤ 1 month before the intended treatment
- Aortic valve is a congenital unicuspid or bicuspid valve; or is non-calcified
- Mixed aortic valve disease (aortic stenosis and aortic regurgitation with predominant aortic regurgitation >3+)
- Any therapeutic invasive cardiac procedure resulting in a permanent implant that is performed within 30 days of the index procedure (unless part of planned strategy for treatment of concomitant coronary artery disease)
- Pre-existing prosthetic heart valve in any position, prosthetic ring, or severe (greater than 3+) mitral insufficiency
- Blood dyscrasias as defined: Leukopenia, acute anemia, thrombocytopenia, history of bleeding diathesis or coagulopathy
- Hemodynamic instability requiring inotropic support or mechanical heart assistance.
- Need for emergency surgery for any reason
- Hypertrophic cardiomyopathy with or without obstruction
- Severe ventricular dysfunction with LVEF ≤20%
- Echocardiographic evidence of intracardiac or aortic mass, thrombus, or vegetation
- Symptomatic or asymptomatic severe occlusive carotid disease requiring concomitant CEA/stenting
- Subject has undergone carotid stenting or carotid endarterectomy within the previous 6 weeks
- Active peptic ulcer or upper GI bleeding within the prior 3 months
- A known hypersensitivity or contraindication to aspirin, heparin, ticlopidine, or clopidogrel, or sensitivity to contrast media, which cannot be adequately pre-medicated
- Recent (within 6 months) CVA or a TIA
- Renal insufficiency (creatinine > 3.0 mg/dL or GFR < 30) and/or renal replacement therapy at the time of screening
- Life expectancy < 12 months due to non-cardiac co-morbid conditions
- Subjects in whom anti-platelet and/or anticoagulant therapy is contraindicated, or who will refuse transfusion
- Subjects who have active bacterial endocarditis or other active infections
- Currently participating in an investigational drug or another device study
- Subjects who have a planned treatment with any other investigational device or procedure during the study follow-up period (90 days)
- Subject with planned concomitant surgical or transcatheter ablation for Atrial Fibrillation during the study follow-up period (90 days)
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Any subject with a balloon valvuloplasty (BAV) within 30 days of the procedure
Neurologic
- Subject had active major psychiatric disease
- Subject has severe visual, auditory, or learning impairment and who are unable to comprehend English and therefore unable to be consented for the study
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Subjects with neurodegenerative or other progressive neurological disease or history of significant head trauma followed by persistent neurologic defaults or known structural brain abnormalities
Angiographic
- Excessive tortuosity in the right radial/brachial/subclavian artery preventing Sentinel System access and insertion
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Subject whose brachiocephalic or left carotid artery reveals significant stenosis, calcification, ectasia, dissection, or aneurysm at the ostium or within 3 cm of the ostium
Magnetic Resonance Imaging
- Subject Body Mass Index (BMI) precluding imaging in scanner
- Contraindications to MRI (subjects with any implantable temporary or permanent pacemaker or defibrillator, metal implants in field of view, metallic fragments, clips, or devices in the brain or eye before TAVR procedure)
- Planned implantation of a pacemaker or defibrillator implantation after TAVR
- Claustrophobia
- Known allergy to gadolinium or contrast agent

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02214277
United States, California | |
Cedars-Sinai Medical Center | |
Los Angeles, California, United States | |
United States, District of Columbia | |
Washington Hospital Center | |
Washington, District of Columbia, United States | |
United States, Florida | |
Morton Plant Hospital | |
Clearwater, Florida, United States | |
United States, Georgia | |
Emory University Hospital | |
Atlanta, Georgia, United States | |
United States, Michigan | |
Henry Ford Hospital | |
Detroit, Michigan, United States | |
United States, Missouri | |
Barnes-Jewish Hospital | |
Saint Louis, Missouri, United States | |
United States, New York | |
Columbia University Medical Center | |
New York, New York, United States | |
Icahn School of Medicine at Mount Sinai | |
New York, New York, United States | |
Weill Cornell Medical Center | |
New York, New York, United States | |
United States, Ohio | |
Cleveland Clinic Foundation | |
Cleveland, Ohio, United States | |
United States, Pennsylvania | |
Hospital of the University of Pennsylvania | |
Philadelphia, Pennsylvania, United States | |
United States, Texas | |
UT Houston / Memorial Hermann | |
Houston, Texas, United States | |
United States, Virginia | |
UVA Advanced Cardiac Valve Center | |
Charlottesville, Virginia, United States | |
United States, Washington | |
UW Medical Center | |
Seattle, Washington, United States | |
Germany | |
Herzzentrum Leipzig - Universitatsklinik | |
Leipzig, Germany, 04289 |
Principal Investigator: | Susheel Kodali, MD | Columbia University | |
Principal Investigator: | Samir Kapadia, MD | The Cleveland Clinic |
Publications of Results:
Responsible Party: | Claret Medical |
ClinicalTrials.gov Identifier: | NCT02214277 |
Other Study ID Numbers: |
CP-10836 |
First Posted: | August 12, 2014 Key Record Dates |
Results First Posted: | May 11, 2018 |
Last Update Posted: | May 11, 2018 |
Last Verified: | April 2018 |
Embolic Protection Edwards SAPIEN THV Edwards SAPIEN XT TAVR Transfemoral Transapical |
Heart Valve Diseases Heart Diseases TAVI Aortic Stenosis Aortic Valve Transcatheter Heart Valve |
Aortic Valve Stenosis Aortic Valve Disease Heart Valve Diseases |
Heart Diseases Cardiovascular Diseases Ventricular Outflow Obstruction |