title: Embolic Protection Devices During TAVI: Current Evidence and Uncertainties.
abstract: Transcatheter aortic valve implantation (TAVI) is now the principal therapeutic option in patients with severe aortic stenosis deemed inoperable or at high surgical risk. Implementing TAVI in a lower risk profile population could be limited by relatively high cerebrovascular event rates related to the procedure. Diffusion-weighted magnetic resonance imaging studies have demonstrated the ubiquitous presence of silent embolic cerebral infarcts after TAVI, with some data relating these lesions to subsequent cognitive decline. Embolic protection devices provide a mechanical barrier against debris embolizing to the brain during TAVI. We review the current evidence and ongoing uncertainties faced with the 3 currently available devices (Embrella, TriGuard and Claret) in TAVI. Studies evaluated neurological damage at 3 levels: clinical, subclinical, and cognitive. Feasibility and safety were analyzed for the 3 devices. In terms of efficacy, all studies were exploratory, but none demonstrated significant reductions in clinical event rates. The Embrella and Claret devices demonstrated significant reductions of the total cerebral lesion volume on diffusion-weighted magnetic resonance imaging. Studies evaluating the effects on cognition were also somewhat inconclusive. In conclusion, despite embolic protection devices demonstrating reductions in the total cerebral lesion volume on diffusion-weighted magnetic resonance imaging, the clinical efficacy in terms of preventing stroke/cognitive decline requires confirmation in larger studies.
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain.
authors.forename: Omar
authors.initials: O
authors.lastname: Abdul-Jawad Altisent
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D001024:Aortic Valve Stenosis / Q000601:surgery*; D002544:Cerebral Infarction / Q000517:prevention & control; D003257:Consumer Product Safety; D057505:Embolic Protection Devices; D006801:Humans; D018810:Magnetic Resonance Angiography; D011474:Prosthesis Design; D020521:Stroke / Q000517:prevention & control; D065467:Transcatheter Aortic Valve Replacement / Q000295:instrumentation* / Q000379:methods
keywords: Ictus; Implante percutáneo de la válvula aórtica; Magnetic resonance imaging; Resonancia magnética; Stroke; Transcatheter aortic valve implantation