Embolic Protection Devices Across TAVR, Carotid Stenting, SVG PCI, and Peripheral Interventions: Scoping Review with ☸SAIMSARA

To map and synthesize the original research evidence on embolic protection devices (EPDs), emphasizing their procedural feasibility, embolic capture or deflection, clinical outcome signals, device-specific limitations, and context-dependent implications across vascular and structural interventions. The review uses 191 references and builds its evidence map from 609 original studies with 1949249 total participants/sample observations (topic-deduplicated ΣN). Across procedures, EPDs reliably capture or deflect embolic material—with debris recovered in up to 99% of protected TAVR cases and cerebral particle deflection reaching 98.7% in experimental models—yet this mechanistic effect translates inconsistently into clinical benefit. The dominant signal is that EPD value is procedure- and anatomy-dependent: carotid stenting registries associate protection with lower stroke or death, while large randomized TAVR evidence has not confirmed routine reduction in early stroke or cognitive decline. These observations support a selective, anatomy-informed approach rather than uniform deployment, while acknowledging that device failure modes and retrieval complications require predefined rescue strategies. Future research should prioritize harmonized endpoints spanning embolic capture, lesion volume, disabling stroke, and patient-centered outcomes within anatomically stratified trials to clarify which patients and procedures derive durable benefit from embolic protection.