The Association of Cerebral Embolic Protection during Transcatheter Aortic Valve Replacement with Periprocedural Neurological Outcomes

ObjectiveCerebral Embolic Protection Devices (CEPs) have been designed to minimize the risk of periprocedural stroke. The clinical significance of these devices, however, is still under debate. AimsWe aimed to compare periprocedural neurological outcomes and mortality in patients undergoing transfemoral transcatheter aortic valve replacement (TF-TAVR) with versus without CEP. MethodsA single-center retrospective analysis of 1101 patients undergoing transfemoral TAVR from August 2017 to May 2025 was performed. CEPs were used routinely at our institution whenever feasible beginning with October 2019. The primary outcome was defined as the incidence of ischemic stroke occurring within 3 days postoperatively. Secondary endpoints included overall neurological outcomes defined as a combined endpoint of stroke, transient ischemic attack (TIA) and delirium within 3 days and short-term all-cause mortality. ResultsOverall, 809 underwent TF-TAVR with CEP, while 292 were treated without. The primary endpoint of clinical ischemic stroke occurred less frequently in the CEP group (1.4% vs. 4.1%), and the group difference revealed a significant result in a univariable Cox regression analysis (p = 0.007). No clinically relevant differences were observed in the incidence of TIA (0.5% vs. 0.7%, p = 0.71) and postprocedural delirium (1.6% vs. 2.4%, p = 0.39). Although the 30-day mortality rate in the control group was higher, the difference did not reach statistical significance (3.9% vs. 1.9%, p = 0.06). ConclusionsThe use of neuroprotection during TAVR was associated with a reduced early periprocedural ischemic stroke.