The risk of stroke is inherent to TAVR and, apart from clinically manifest events, there is abundant evidence of cerebral embolic lesions during TAVR provided by studies using diffusion weighted MRI or transcranial doppler ultrasound. Several devices have been developed to reduce the risk of stroke, though they have been assessed by relatively small trials with controversial outcomes. The aim of this study was to gather all available evidence and carry out a meta-analyzis on the safety and efficacy of embolic protection devices during TAVR.
This meta-analyzis inc luded 8 studies with a total 1285 patients. Success rate of embolic protection devices was 94.5%.
Global incidence of stroke was 4.8% in patients using embolic protection devices and 6% in patients with no protection. Silent new ischemic lesions rate detected by diffusion MRI was 80%.
The use of protection devices was not associated to differences in mortality at 30 days (OR: 0.43, CI 95% 0.18 to 1.05; p=0.3) but it was associated to a lower rate of stroke in the same period (OR: 0.45, CI 95% 0.31 to 0.98; p=0.04), with a number needed to treat of 33 patients to prevent a new event.
There were no differences in number of new lesions, but the new devices were associated to a lower total volume of lesions. The greatest benefit of embolic protection devices was observed in self-expandable valves.
Conclusion
The use of embolic protection devices was not associated to a reduction in mortality during TAVR but to a lower rate of stroke at 30 days. There was no reduction in new lesions diagnosed by diffusion MRI, but there was a reduction in lesion volume.
Título original: Cerebral protection during TAVR reduces the incidence of major cerebrovascular events: results from an up-to-date systematic review and meta-analysis.
Presentador: L. Testa.
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