The Role of Cerebral Embolic Protection in Transcatheter Aortic Valve Replacement

Abstract

In transcatheter aortic valve replacement (TAVR), stroke remains one of the most devastating complications. As a result, cerebral embolic protection devices (CEPD) have been developed to prevent cerebral embolization in order to lower the stroke risk. Emboli can either be filtered or deflected depending on the type of CEPD. The goal of this review is to provide an overview of all currently available CEPD and to discuss the results of the most relevant studies concerning cerebral embolic protection in TAVR.

Catheter-Based Therapies: Current Practices and Considerations

“…The REFLECT II trial proved that the TriGUARD group had higher safety when compared to the unprotected group (15.9% vs. 7%). This study had successful device positioning in 59.3% of the patients [59].…”

“…There are many types of CEPD that have their own set of pros and cons. Overall the filtration needs to protect the major cerebral arteries throughout the entire procedure [59].…”

“…The second-generation of this device, TriGUARD HDH was invented and then also evaluated in other studies. The DEFLECT III trial showed less neurological deficits as defined by the National Institutes of Health Stroke Scale (NIHSS) and cognitive function improvement [59]. TriGUARD 3 is an update of the current TriGUARD HDH that provides easier usage, extensive coverage of all three major branches, and less interference with the TAVR.…”

“…Currently this system is not widely available for use as there is not enough clinical data. The CENTER trial will be initiated to evaluate this system [59].…”

“…The study noted that no cerebrovascular or cardiovascular events were seen at 30 days follow-up. However further studies need to be done to see improvement in clinical outcomes using this device [59].…”