Ischemic Stroke With Cerebral Protection System During Transcatheter Aortic Valve Replacement

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Michael Megaly1, Paul Sorajja2, João L Cavalcante2

  • 1Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota; Division of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, Minnesota.

JACC. Cardiovascular Interventions
|September 25, 2020
PubMed

Insights

The Sentinel cerebral protection system (CPS) significantly reduces ischemic stroke risk during transcatheter aortic valve replacement (TAVR). While associated with higher hospitalization costs, CPS use lowers stroke incidence and in-hospital mortality.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • The clinical effectiveness of the Sentinel cerebral protection system (CPS) in preventing strokes during transcatheter aortic valve replacement (TAVR) remains a subject of debate.
  • Evaluating in-hospital outcomes associated with CPS use in TAVR is crucial for understanding its clinical utility.

Purpose of the Study:

  • To assess the impact of the Sentinel CPS on in-hospital outcomes in patients undergoing TAVR.
  • To determine the efficacy of the Sentinel CPS in mitigating the risk of clinical ischemic stroke post-TAVR.

Main Methods:

  • A retrospective analysis of the Nationwide Inpatient Sample database (2017) was performed.
  • Hospitalizations for TAVR were identified, and a 1:2 propensity score-matched analysis compared outcomes between patients with and without CPS use.
  • The primary endpoint was the occurrence of ischemic strokes.

Main Results:

  • The study identified 36,220 TAVR hospitalizations (525 with CPS, 35,695 without).
  • After propensity score matching, CPS use was associated with a significantly lower risk of ischemic stroke (1% vs. 3.8%, OR: 0.243, p=0.003).
  • CPS use was linked to increased hospitalization costs ($47,783 vs. $44,578, p=0.002) but independently associated with reduced ischemic stroke risk (OR: 0.380, p=0.032).

Conclusions:

  • The Sentinel CPS is associated with a reduced incidence of ischemic stroke and in-hospital mortality in TAVR patients.
  • Its use did not increase procedural complication risks but did elevate index hospitalization costs.
  • The findings support the use of Sentinel CPS for stroke prevention in TAVR procedures, balancing efficacy with cost considerations.
Abstract

Keywords:
Sentinelcerebral embolic protection devicecerebral protection systemtranscatheter aortic valve replacement

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