The rate of cerebrovascular events in TAVR hovers about 4% in most of the current studies, regardless the center, the operator or the prosthetic valve. At present, no scores can adequately predict which patients run the highest risk of stroke during TAVR, and the routine use of cerebral protection devices remains controversial.
The SENTINEL study randomized 347 patients 2:1 to embolic protection devices during TAVR vs. a control group with no protection. All anatomical data ─valve, aorta and extra cranial vessels─ were collected and analyzed.
Anatomical variations such as type of arch, root angulation and amount of calcium, can increase the chance of stroke. However, device benefits were consistent across subgroups.
Paradoxically, the greatest events reduction using cerebral protection devices was observed in patients with lower calcium burden. This might be due to the more friable nature of perivalvular tissue at higher risk of embolization.
This information confirms the unpredictable nature of periprocedural stroke and supports the routine use of cerebro-embolic protection devices until more, larger, studies come along.
Original title: Anatomical predictors of stroke prevention during transcatheter aortic valve implantation – The SENTINEL Trial.
Presenter: Hasan Jilaihawi.
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