Anticipating stroke in patients undergoing transcatheter aortic valve replacement.

INTRODUCTION

Transcatheter aortic valve replacement (TAVR) has transformed treatment of severe aortic stenosis, offering a less invasive alternative to surgery. Despite advances, stroke remains a serious complication, impacting morbidity, mortality, and long-term cognitive function, thus the need for effective prevention strategies.

AREAS COVERED: Based on a targeted review of the PubMed literature, this review addresses mechanisms and risk factors for stroke after TAVR and evaluates current preventive approaches. Cerebral embolic protection devices (CEPDs), particularly the Sentinel system, are discussed alongside other devices. Antithrombotic strategies before, during, and after TAVR are also reviewed, emphasizing the balance between thromboembolic protection and bleeding risk in an elderly population.

EXPERT OPINION: While some studies suggest CEPDs may reduce stroke, randomized trials have not confirmed broad and robust benefit, and high cost limits routine adoption. Future work should focus on high-risk subgroups, device refinement, and large-scale trials. For now, individualized antithrombotic therapy and selective CEPD use remain central to stroke prevention in TAVR.