Cerebral embolic protection and severity of stroke following transcatheter aortic valve replacement

• Published in: Catheterization and cardiovascular interventions 2022-11, Vol.100 (5), p.810-820
• Main Authors: Isogai, Toshiaki, Vanguru, Husitha Reddy, Krishnaswamy, Amar, Agrawal, Ankit, Spilias, Nikolaos, Shekhar, Shashank, Saad, Anas M, Verma, Beni Rai, Puri, Rishi, Reed, Grant W, Popović, Zoran B, Unai, Shinya, Yun, James J, Uchino, Ken, Kapadia, Samir R
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic valve; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Embolic Protection Devices; Female; Humans; Intracranial Embolism - diagnostic imaging; Intracranial Embolism - epidemiology; Intracranial Embolism - etiology; Neuroimaging; Original ‐ Clinical Science; Patients; Prospective Studies; Retrospective Studies; Risk Factors; Stroke; Stroke - epidemiology; Stroke - etiology; Stroke - prevention & control; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome; Valvular and Structural Heart Diseases
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.30340

The cerebral embolic protection (CEP) device captures embolic debris during transcatheter aortic valve replacement (TAVR). However, the impact of CEP on stroke severity following TAVR remains unclear. Therefore, we aimed to examine whether CEP was associated with reduced severity of stroke following TAVR. This was a retrospective cohort study of 2839 consecutive patients (mean age: 79.2 ± 9.5 years, females: 41.5%) who underwent transfemoral TAVR at our institution between 2013 and 2020. We categorized patients into Sentinel CEP users and nonusers. Neuroimaging data were reviewed and the final diagnosis of a cerebrovascular event was adjudicated by a neurologist blinded to the CEP use or nonuse. We compared the incidence and severity (assessed by the National Institutes of Health Stroke Scale [NIHSS]) of stroke through 72 h post-TAVR or discharge between the two groups using stabilized inverse probability of treatment weighting (IPTW) of propensity scores. Of the eligible patients, 1802 (63.5%) received CEP during TAVR and 1037 (36.5%) did not. After adjustment for patient characteristics by stabilized IPTW, the rate of overall stroke was numerically lower in CEP users than in CEP nonusers, but the difference did not reach statistical significance (0.49% vs. 1.18%, p = 0.064). However, CEP users had significantly lower rates of moderate-or-severe stroke (NIHSS ≥ 6: 0.11% vs. 0.69%, p = 0.013) and severe stroke (NIHSS ≥ 15: 0% vs. 0.29%, p = 0.046). Stroke following CEP use (n = 8), compared with stroke following CEP nonuse (n = 15), tended to carry a lower NIHSS (median [IQR], 4.0 [2.0-7.0] vs. 7.0 [4.5-19.0], p = 0.087). Four (26.7%) out of 15 patients with stroke following CEP nonuse died within 30 days, with no death after stroke following CEP use. CEP use may be associated with attenuated severity of stroke despite no significant difference in overall stroke incidence compared with CEP nonuse. This finding is considered hypothesis-generating and needs to be confirmed in large prospective studies.