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Published on: June 3, 2018
Role of Cerebral Embolic Protection Devices in Patients Undergoing Transcatheter Aortic Valve Replacement: An Updated
Arpanjeet Kaur1, Arshdeep S Dhaliwal2, Sumit Sohal3
1Department of Medicine Icahn School of Medicine at Mount Sinai Morningside/West- New York New York NY.
Insights
Cerebral embolic protection devices (CEPD) did not significantly reduce stroke or improve other outcomes during transcatheter aortic valve replacement, according to a meta-analysis. Further research is needed to clarify their role in TAVR procedures.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Medical Devices
Background:
- Cerebral embolic protection devices (CEPD) aim to prevent ischemic brain injury during transcatheter aortic valve replacement (TAVR).
- Previous studies on CEPD effectiveness during TAVR have yielded mixed results.
- An updated meta-analysis was conducted to evaluate the impact of CEPD on clinical, neurological, and safety outcomes in TAVR.
Conclusions:
- The use of cerebral embolic protection devices (CEPD) during transcatheter aortic valve replacement (TAVR) is not associated with a significant reduction in clinical, neurological, or safety risks.
- Current evidence does not support a routine benefit of CEPD in TAVR procedures based on the analyzed outcomes.
Background:
Cerebral embolic protection devices (CEPD) capture embolic material in an attempt to reduce ischemic brain injury during transcatheter aortic valve replacement. Prior reports have indicated mixed results regarding the benefits of these devices. With new data emerging, we performed an updated meta-analysis examining the effect of CEPD during transcatheter aortic valve replacement on various clinical, neurological, and safety parameters.
Methods And Results:
A comprehensive review of electronic databases was performed comparing CEPD and no-CEPD in transcatheter aortic valve replacement. Primary clinical outcome was all-cause stroke. Secondary clinical outcomes were disabling stroke and all-cause mortality. Neurological outcomes included worsening of the National Institutes of Health Stroke Scale score, Montreal Cognitive Assessment score from baseline at discharge, presence of new ischemic lesions, and total lesion volume on neuroimaging. Safety outcomes included major or minor vascular complications and stage 2 or 3 acute kidney injury. Seven randomized controlled trials with 4016 patients met the inclusion criteria. There was no statistically significant difference in the primary clinical outcome of all-cause stroke; secondary clinical outcomes of disabling stroke, all-cause mortality, neurological outcomes of National Institutes of Health Stroke Scale score worsening, Montreal Cognitive Assessment worsening, presence of new ischemic lesions, or total lesion volume on diffusion-weighted magnetic resonance imaging between CEPD versus control groups. There was no statistically significant difference in major or minor vascular complications or stage 2 or 3 acute kidney injury between the groups.
Conclusions:
The use of CEPD in transcatheter aortic valve replacement was not associated with a statistically significant reduction in the risk of clinical, neurological, and safety outcomes.
