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Preventing Strokes After Transcatheter Aortic Valve Replacement

By Jonathan Springston, Editor, Relias Media

Investigators have found marginal benefit when it comes to using a cerebral embolic protection (CEP) device to lower the risk for stroke after a transcatheter aortic valve replacement (TAVR).

Although TAVR is a common, minimally invasive procedure used to replace the aortic valve with a catheter, there is a possibility of debris embolization from the valve that can cause a stroke during or after the procedure. Investigators have theorized a CEP device could trap this debris before it reaches the brain, thereby lowering stroke risk.

Led by the Cleveland Clinic, a group of investigators recruited 3,000 patients from Australia, Europe, and North America with aortic stenosis to undergo transfemoral TAVR with CEP (CEP group) or without CEP (control group). Patients were assigned to groups randomly (1,501 to the CEP group, 1,499 to the control group).

The results seem mixed. CEP devices were deployed successfully in 1,406 of 1,489 patients. However, the authors reported the incidence of stroke within 72 hours after TAVR or before discharge did not differ significantly between the CEP group and control group (2.3% vs. 2.9%; 95% confidence interval, -1.7 to 0.5; P = 0.30). But after conducting a secondary analysis, researchers reported a 60% relative risk reduction in disabling stroke through 72 hours or time of hospital discharge in patients treated with the CEP device (0.5% with TAVR and CEP vs. 1.3% with TAVR only; P = 0.02).

“Among patients with aortic stenosis undergoing transfemoral TAVR, the use of CEP did not have a significant effect on the incidence of periprocedural stroke, but on the basis of the 95% confidence interval around this outcome, the results may not rule out a benefit of CEP during TAVR,” the authors concluded.

For more on this and related subjects, be sure to read the latest issues of Clinical Cardiology Alert and Neurology Alert. For more stroke-specific education, check out the Relias Media sourcebook, Stroke 2022: Advances in Treatment and Care.