International journal of cardiology. Heart & vasculature · 2025
Effectiveness of cerebral embolic protection during transcatheter aortic valve replacement: A systematic review and meta-analysis of randomized trials.
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Caminiti Rodolfo, Ielasi Alfonso, Vetta Giampaolo, Parlavecchio Antonio, Della Rocca Domenico Giovanni, Moscardelli Silvia, Marrone Andrea, Laterra Giulia, Tespili Maurizio, Vizzari Giampiero, Barbanti Marco, Micari Antonio
Аннотация
BACKGROUND: Cerebral embolism remains a concern during transcatheter aortic valve replacement (TAVR). Cerebral embolic protection (CEP) devices have been developed to mitigate this risk, but their clinical benefit remains unclear.
METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials comparing TAVR with and without CEP devices. Primary endpoint was overall stroke; secondary endpoints included disabling stroke, all-cause mortality, life-treating bleeding, vascular complications related to CEP access and acute kidney injury.
RESULTS: Eight trials comprising 11,625 patients (group CEP, n = 5,843 patients; group NCEP, n = 5,782 patients, 57.3 % male, 81.5 mean age years) were included. No significant differences were found for primary endpoint, overall stroke (RR 1.03, 95 % CI 0.82-1.29), and secondary outcomes between CEP and non-CEP groups at 30 days follow-up. Complications related to CEP access were minimal, 1.1 % (95 % CI: -0.6 to 2.8).
CONCLUSIONS: CEP devices do not significantly reduce short-term stroke or major complications after TAVR. However, given the prevalence of silent cerebral ischemia, further studies are needed to assess long-term neurological outcomes and identify high-risk subgroups who may benefit.
METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials comparing TAVR with and without CEP devices. Primary endpoint was overall stroke; secondary endpoints included disabling stroke, all-cause mortality, life-treating bleeding, vascular complications related to CEP access and acute kidney injury.
RESULTS: Eight trials comprising 11,625 patients (group CEP, n = 5,843 patients; group NCEP, n = 5,782 patients, 57.3 % male, 81.5 mean age years) were included. No significant differences were found for primary endpoint, overall stroke (RR 1.03, 95 % CI 0.82-1.29), and secondary outcomes between CEP and non-CEP groups at 30 days follow-up. Complications related to CEP access were minimal, 1.1 % (95 % CI: -0.6 to 2.8).
CONCLUSIONS: CEP devices do not significantly reduce short-term stroke or major complications after TAVR. However, given the prevalence of silent cerebral ischemia, further studies are needed to assess long-term neurological outcomes and identify high-risk subgroups who may benefit.