Key result
Flushing TAVI valves with carbon dioxide reduces MRI cerebral lesions by ~53% versus conventional saline.
Why the study?
Stroke rates remain unchanged after TAVI despite advances, with cerebral embolic protection trials failing to reduce rates, and the potential role of air emboli had never been investigated.
Does carbon dioxide flushing of TAVI valves reduce vascular brain injury in patients undergoing TAVI?
RCT (n=60)
Blinded
1:1
No
Does carbon dioxide flushing of TAVI valves reduce vascular brain injury in patients undergoing TAVI?
Absolute Event Rate: 4% vs 8.5%
p-value: p=0.031
Carbon dioxide flushing of TAVI valves is a feasible, accessible method that significantly reduces the number of new cerebral lesions detected on MRI post-procedure.
CO₂ flushing may limit periprocedural brain injury in TAVI; extends neuroprotective strategies beyond failed embolic protection devices.
BACKGROUND: Stroke remains a significant concern in patients undergoing Transcatheter Aortic Valve Implantation (TAVI). Despite advances in TAVI technology and techniques, rates have remained unchanged, with trials of Cerebral embolic protection devices (CEPD) failing to reduce rates. The concept of air emboli has never been previously investigated in TAVI procedures. We hypothesize that gaseous emboli could play a significant role in TAVI and that carbon dioxide (COâ) flushing of the TAVI valves could reduce the incidence of new neurological lesions post-TAVI. AIMS: To demonstrate the neuroprotective benefits of COâ flushing in TAVI. METHODS: INTERCEPTavi is a pilot single centre, blinded, randomized controlled trial that studied the effects of flushing TAVI valves with COâ versus conventional saline on neurological outcomes post TAVI assessed using MRI and transcranial doppler(TCD). Patients with aortic stenosis were randomised after access was obtained. Peri-procedure TCD assessed solid and gas emboli to the brain. Post-procedure, patients underwent brain MRI to detect lesions. Here we report the primary outcome of feasibility, as well as the secondary MRI and mechanistic TCD data. RESULTS: 60 patients were recruited and randomised 1:1 to COâ and saline flushing (TAVI-COâ) versus saline flushing only (TAVI-S). COâ flushing significantly reduced the average number of lesions per patient (TAVI-COâ 4 lesions/patient vs TAVI-S 8.5 lesions/patient; P=0.031). The total infarct area was numerically lower in the COâ group (40.32 mm² vs 93.20 mm²), although this did not reach statistical significance (p=0.111). Similarly, Transcranial Doppler (TCD) showed fewer micro-embolic signals in the COâ arm, primarily due to a reduction in gaseous emboli, but this difference was not statistically significant (p=0.5). CONCLUSIONS: INTERCEPTavi is a pioneering first-in-man randomised trial that demonstrated that COâ flushing of the TAVI reduces the number of cerebral lesions measured on MRI. COâ is an accessible, cost-effective method that can be easily implemented in any catheter laboratory to provide neurological advantages.
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Khawaja et al. (2026) conducted an RCT in Aortic stenosis (n=60). Carbon dioxide (CO2) flushing vs. Conventional saline flushing was evaluated on Average number of cerebral lesions per patient on MRI (p=0.031). Flushing TAVI valves with carbon dioxide significantly reduced the average number of cerebral lesions per patient on MRI compared to conventional saline flushing (4 vs 8.5 lesions/patient; P=0.031).
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