Cerebral Embolic Protection Devices (CEPDs) During Transcatheter Aortic Valve Implantation (TAVI): A Meta-Analysis of...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Neurology

Background:

• Transcatheter aortic valve implantation (TAVI) is linked to a risk of procedure-related stroke.
• Cerebral embolic protection devices (CEPDs) aim to mitigate this risk, but their effectiveness is debated.

Purpose of the Study:

• To evaluate the efficacy and safety of CEPDs in patients undergoing TAVI through a systematic review of randomized controlled trials (RCTs).

Main Methods:

• Systematic search of major databases up to April 2025 for RCTs.
• Critical appraisal using the Cochrane Risk of Bias (ROB-2) tool.
• Meta-analysis of risk ratios and trial sequential analysis (TSA) to assess outcomes.

Main Results:

• Eight RCTs (11,589 patients) showed no significant difference in overall stroke incidence (including disabling/non-disabling) between CEPD and control groups.
• No significant differences were observed in all-cause mortality, transient ischemic attacks, bleeding, acute kidney injury, delirium, or pacemaker implantation.
• A transient improvement in cognitive function was noted with CEPDs, but not sustained; TSA indicated insufficient evidence to refute efficacy.

Conclusions:

• CEPDs do not significantly reduce the incidence of overall, disabling, or non-disabling stroke post-TAVI.
• No significant impact on all-cause mortality was found.
• Current evidence suggests limited benefit of routine CEPD use in TAVI, despite transient cognitive improvements.