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Published on: January 18, 2018
Routine cerebral embolic protection during TAVR: A meta-analysis and trial sequential evidence from 11,000 randomized
Zeyad Kholeif1, Ahmed Elmorsy Mohamed2, Mohamed Elnady3
1Cardiology Department, Mayo Clinic, Rochester, MN, USA; Baptist Hospital of Southeast Texas, Beaumont, TX, USA.
Journal of Cardiology
|May 20, 2026
Summary
Routine cerebral embolic protection (CEP) during transcatheter aortic valve replacement (TAVR) does not significantly reduce stroke incidence. This meta-analysis found no difference in overall, disabling, or non-disabling strokes, suggesting a limited role for routine CEP.
Area of Science:
- Cardiology
- Interventional Cardiology
- Neurology
Background:
- Transcatheter aortic valve replacement (TAVR) is a growing procedure for aortic stenosis.
- Cerebral embolic protection (CEP) devices aim to reduce stroke risk during TAVR.
- The routine use and efficacy of CEP in TAVR remain subjects of ongoing research.
Purpose of the Study:
- To conduct an updated meta-analysis on the effectiveness of routine cerebral embolic protection (CEP) during TAVR.
- To assess the impact of CEP on the incidence of disabling and non-disabling strokes post-TAVR.
- To evaluate the safety profile of routine CEP use in TAVR procedures.
Main Methods:
- Systematic search of electronic databases for randomized controlled trials (RCTs) comparing CEP with no CEP in TAVR patients, up to August 2025.
- Primary outcomes included overall stroke, disabling stroke, and non-disabling stroke incidence at 2-5 days and 30 days post-procedure.
- Random-effects models, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria, and trial sequential analysis were employed.
Main Results:
- Eight RCTs with 11,692 patients were analyzed.
- No statistically significant difference in overall stroke incidence was found between CEP and control groups at 2-5 days (RR 0.95; 95% CI 0.75-1.19) or 30 days (RR 0.93; 95% CI 0.57-1.53).
- Rates of disabling and non-disabling strokes, as well as safety outcomes (major bleeding, vascular complications, acute kidney injury), were similar between groups.
Conclusions:
- Routine cerebral embolic protection (CEP) strategy during TAVR is not associated with a statistically significant reduction in overall, disabling, or non-disabling stroke.
- The neutral effect on safety endpoints suggests a limited role for routine CEP use in TAVR.
- Potential benefits in specific high-risk patient groups or device-specific effects cannot be entirely excluded.
