Related Experiment Video
Updated: May 2, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Stroke following transcatheter aortic valve implantation. Is neuroprotection justified?
Maciej Dąbrowski1, Adam Witkowski1
1Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
Insights
Transcatheter aortic valve implantation (TAVI) can cause neurological events like stroke. Neuroprotection devices aim to reduce these complications, but their efficacy requires further randomized trial assessment.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Degenerative aortic stenosis (AS) is a common valvular heart disease.
- Surgical aortic valve replacement (SAVR) is standard for symptomatic AS.
- Transcatheter aortic valve implantation (TAVI) is an alternative for high-risk patients, but carries neurological risks.
Purpose of the Study:
- To review neuroprotection devices developed for TAVI.
- To discuss the current evidence regarding TAVI-associated neurological events.
- To provide recommendations for neuroprotection device use in TAVI.
Main Methods:
- Review of published randomized trials and registries on TAVI and neurological events.
- Description of neuroprotection devices (Embrella, SMT, Claret System) and their mechanisms.
- Analysis of current data on TAVI vs. SAVR neurological event rates.
Main Results:
- TAVI is associated with a higher incidence of stroke and transient ischemic attack compared to SAVR.
- Neuroprotection devices are designed to mitigate microembolization during TAVI.
- Randomized trials specifically assessing neuroprotection device efficacy are currently lacking.
Conclusions:
- Neuroprotection devices are a potential strategy to reduce TAVI-related neurological complications.
- Current evidence does not yet support routine use of these devices in all TAVI patients.
- Limited use in high-risk neurological complication patients (e.g., prior stroke, severe calcification) is suggested pending further data.
Abstract:
Degenerative aortic stenosis (AS) is the most frequent type of valvular heart disease. In patients with symptomatic AS surgical aortic valve replacement (SAVR) is a recommended treatment strategy. Due to a high risk of perioperative mortality, up to 30% of patients with AS are considered not suitable for SAVR. In the last 10 years dynamic development of transcatheter aortic valve implantation (TAVI) has been observed as an alternative to SAVR in patients with AS and high risk for surgery. In the two randomized trials published so far and numerous registries, stroke and transient ischemic attack still remain serious periprocedural complications after TAVI. Because the majority of these episodes are driven by microembolization during the procedure, different neuroprotection devices were developed and clinically tested. Embrella and SMT are deflector devices, using a microporous membrane mounted on a nitinol frame, designed to cover the ostia of the brachiocephalic trunk and the left carotid artery. The Claret System is designed to filter cerebral blood flow within the ostia of the brachiocephalic trunk, as well as in the left common carotid artery. Randomized clinical data have demonstrated that TAVI is associated with more neurological events compared to SAVR. However, to date the efficacy of the neuroprotection systems has not been assessed in randomized trials. Before we know the results of such trials, the use of the devices should be limited to patients at high risk of neurological complications, such as patients with previous stroke, massive calcification on aortic leaflets, annulus and porcelain aorta.
