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Updated: Aug 5, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Stroke Rates and Clinical Outcomes After Transcaval Transcatheter Aortic Valve Replacement With and Without Central
Tyler Andrews1, Victoria Coombe1, Ritik Patel2
1Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan.
Insights
Cerebral embolic protection (CEP) use during transcaval transcatheter aortic valve replacement (TAVR) did not significantly alter 30-day stroke rates. Outcomes were similar between patients with and without CEP, suggesting further research is needed for high-risk TAVR cohorts.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- Alternate access transcatheter aortic valve replacement (TAVR) is linked to increased stroke risk.
- Cerebral embolic protection (CEP) use in alternative access TAVR remains incompletely defined.
- 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 transcaval TAVR with and without cerebral embolic protection (CEP).
- To assess the safety and efficacy of CEP in this patient population.
Main Methods:
- Retrospective cohort study of 197 patients undergoing transcaval TAVR (2014-2025).
- Cerebral embolic protection (CEP) utilized with the SENTINEL device when feasible after 2017.
- Primary outcome: 30-day stroke; Secondary outcomes: 30-day MACE-3 (myocardial infarction, stroke, cardiac death).
Main Results:
- Overall 30-day stroke rate was 2.54%, with similar incidence between CEP (1.69%) and non-CEP (2.9%) groups (P=.68).
- Major adverse cardiac events-3 (MACE-3) and mortality were low and comparable across groups.
- Patients receiving CEP experienced a shorter hospital stay.
Conclusions:
- Cerebral embolic protection (CEP) use in transcaval TAVR was associated with similar 30-day stroke and MACE-3 rates compared to no CEP.
- The findings represent the largest description of stroke rates in transcaval TAVR with and without CEP.
- Further investigation is warranted to define the protective role of CEP in high-risk TAVR patients.
Background:
Alternate access transcatheter aortic valve replacement (TAVR) is associated with higher stroke rates. However, the use of cerebral embolic protection (CEP) in alternative access TAVR is not well defined. We sought to describe the 30-day stroke incidence and clinical outcomes in patients undergoing transcaval TAVR with and without CEP.
Methods:
We performed a single-center retrospective cohort study of 197 patients who underwent transcaval TAVR from 2014 to 2025. CEP, when anatomically feasible, was employed using the SENTINEL device (Boston Scientific) after its commercial availability in 2017. The primary outcome was 30-day stroke. Secondary outcomes included 30-day major adverse cardiac events (MACE-3 [defined as the composite of nonfatal myocardial infarction, stroke, and cardiac death]).
Results:
Of 197 patients, 59 received CEP and 138 did not. Baseline characteristics, including prior stroke and transient ischemic attack, were similar between groups. Overall, 30-day stroke was rare (2.54%) and similar between CEP and non-CEP patients (1.69% vs 2.9%, P = .68). Numerically, more patients without CEP experienced a stroke. Secondary outcomes, including 30-day mortality, myocardial infarction, and composite MACE-3, were similarly low across groups. A shorter hospital stay was observed with CEP use.
Conclusions:
In the largest description of stroke rates in transcaval TAVR with and without CEP, 30-day stroke and MACE-3 events were similar with and without CEP use. A further study is warranted to describe the protective utility of CEP in high-risk TAVR cohorts.
