Cerebral embolic protection devices during transcatheter aortic valve replacement are safe and feasible, but current randomized trials have not demonstrated a significant reduction in overall stroke.
Do cerebral embolic protection devices reduce the incidence of stroke in patients undergoing transcatheter aortic valve replacement?
While cerebral embolic protection devices during TAVR do not significantly reduce the overall rate of stroke or new ischemic brain lesions, they may reduce the incidence of disabling stroke, warranting further evaluation in larger trials.
Transcatheter aortic valve replacement (TAVR) is a treatment option for patients with symptomatic severe aortic stenosis across the entire spectrum of surgical risk. Recent trial data have led to the expansion of TAVR into lower-risk patients. With iterative technological advances and successive increases in procedural experience, the occurrence of complications following TAVR has declined. One of the most feared complications remains stroke, and patients consider stroke a worse outcome than death. There has therefore been great interest in strategies to mitigate the risk of stroke in patients undergoing TAVR. In this paper, we will discuss mechanisms and predictors of stroke after TAVR and describe the currently available cerebral embolic protection devices, including their design and relevant clinical studies pertaining to their use. We will also review the current overall evidence base for cerebral embolic protection during TAVR and ongoing randomized controlled trials. Finally, we will discuss our pragmatic recommendations for the use of cerebral embolic protection devices in patients undergoing TAVR.
Iskander et al. (Mon,) conducted a review in Severe aortic stenosis. Cerebral embolic protection devices vs. No cerebral embolic protection was evaluated. Cerebral embolic protection devices during transcatheter aortic valve replacement are safe and feasible, but current randomized trials have not demonstrated a significant reduction in overall stroke.