Key result
Current evidence supports the use of cerebral protection devices primarily in TAVI patients who are at highest risk for stroke, whereas data do not support their routine use in other transcatheter procedures.
Why the study?
Stroke remains a devastating complication of cardiovascular interventions, prompting a review of stroke rates and the current evidence for cerebral protection devices across different procedures.
Do cerebral protection devices reduce stroke and cerebral embolic lesions in patients undergoing transcatheter cardiovascular interventions?
Do cerebral protection devices reduce stroke and cerebral embolic lesions in patients undergoing transcatheter cardiovascular interventions?
Answers are grounded in this paper and cite their sources.
While cerebral protection devices are feasible and safe, current evidence only supports their potential benefit in high-risk TAVI patients, with insufficient data to support routine use in other transcatheter interventions.
PURPOSE OF REVIEW: Stroke remains a devastating complication of cardiovascular interventions. This review is going to discuss stroke rates and outcomes in different cardiovascular procedures with a highlight on the current evidence for the use of cerebral protection devices (CPD). RECENT FINDINGS: Depending on the quality of neurological assessment, stroke occurs in up to 9.1% after TAVI, 3.9% after mitral clipping, 3.1% in LAAO patients, 0.4% after PCIs, and 1.8% after catheter ablation. CPDs are available for routine use. They are easy to use in most anatomies, feasible, and safe. Data on clinical impact and stroke reduction from RCTs are still missing. Most evidence for the routine use of CPDs exists in TAVI patients, who are at the highest risk. The PROTECTED TAVI RCT will shed more light on the clinical impact of CPD-use in TAVI patients. In other cardiovascular procedures like mitral clipping, PCIs, and ablation, the current data do not support the routine use of CPDs in these patients.
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Haußig et al. (2020) conducted a review in Cardiovascular interventions (TAVI, mitral clipping, LAAO, PCI, catheter ablation). Cerebral protection devices (CPD) vs. No cerebral protection device was evaluated. Current evidence supports the use of cerebral protection devices primarily in TAVI patients who are at highest risk for stroke, whereas data do not support their routine use in other transcatheter procedures.
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