Stroke Rates and Clinical Outcomes After Transcaval Transcatheter Aortic Valve Replacement With and Without Central...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Devices

Background:

• Alternate access transcatheter aortic valve replacement (TAVR) is linked to increased stroke risk.
• The role of cerebral embolic protection (CEP) in alternative access TAVR remains unclear.
• This study investigates stroke incidence and outcomes in transcaval TAVR with and without CEP.

Purpose of the Study:

• To evaluate the 30-day stroke incidence in patients undergoing transcaval TAVR.
• To compare clinical outcomes between patients who received CEP and those who did not.
• To assess the safety and efficacy of CEP in this specific TAVR approach.

Main Methods:

• A single-center retrospective cohort study of 197 patients undergoing transcaval TAVR (2014-2025).
• Cerebral embolic protection (CEP) using the SENTINEL device was employed when anatomically feasible after 2017.
• Primary outcome: 30-day stroke; Secondary outcomes: 30-day MACE-3 (myocardial infarction, stroke, cardiac death).

Main Results:

• Of 197 patients, 59 received CEP and 138 did not; baseline characteristics were similar.
• Overall 30-day stroke rate was 2.54%, with no significant difference between CEP (1.69%) and non-CEP (2.9%) groups (P=.68).
• Secondary outcomes including 30-day mortality and MACE-3 were low and similar; shorter hospital stay observed with CEP.

Conclusions:

• 30-day stroke and MACE-3 events were similar in transcaval TAVR patients with and without cerebral embolic protection (CEP).
• This study represents the largest description of stroke rates in transcaval TAVR comparing CEP use.
• Further investigation is warranted to define the protective utility of CEP in high-risk TAVR populations.