Cerebral embolic protection is a strategy to prevent embolization of thrombotic or calcific debris during transcatheter aortic valve replacement (TAVR). A number of randomized and controlled studies have tested the safety and efficacy of various devices, though none of them have enough statistical power to show significant differences in end points. While preliminary…
Remote Ischemic Preconditioning in Carotid PCI: Safe and Effective?
Remote ischemic preconditioning (RIPC) can prevent recurrent ischemic events in patients with acute or chronic cerebral ischemia. However, is remains unclear whether RIPC could prevent an ischemic event in the context of carotid PCI in patients with severe carotid artery stenosis. The study included patients with severe carotid artery stenosis randomized to RIPC, vs.…
How Important Is Controlling Risk Factors for the Prevention of a Stroke?
There has been a recent decline of about 20% to 40% in the incidence of cerebrovascular accidents (stroke). Although this is attributed to the improvement of risk factor control, the reason behind it is not utterly clear. This study estimated the impact of modifiable cardiovascular risk factors on the incidence of stroke between 1995 and…
Post TAVR Cognitive Function at Short Term: Better or Worse?
There is little information on the short and mid-term evolution of cognitive function after transcatheter aortic valve replacement (TAVR). The aim of this study was to describe global changes in cognitive function and changes in specific cognitive domains one year after TAVR. Fifty one patients undergoing TAVR, median age 80, were prospectively followed…
Carotid Revascularization After Stroke: When Should It Be Performed?
In 2006, the American Heart Association guidelines recommended that carotid revascularization be performed within 2 weeks of stroke based on data from 2 randomized trials on carotid endarterectomy. This study aimed to determine whether the time between the event and revascularization has decreased after these guidelines were issued, and the proportion of patients receiving some sort of revascularization (endarterectomy…
Embolic Protection Devices Reduce the Risk of New Lesions During TAVR
The aim of this study was to investigate the efficacy and safety of cerebral protection devices during transcatheter aortic valve replacement (TAVR). All randomized controlled trials investigating the efficacy of cerebral protection devices during TAVR are relatively small and lack statistical power for definitive conclusions. That is the reason why this systematic review…
TAVI May Improve Cognitive Function in Patients with Prior Deterioration
This work studies cognitive evolution after transcatheter aortic valve implantation (TAVI). Previous smaller studies reported conflicting results on cognitive function after TAVI. This study prospectively included 229 patients who were ≥70 years old, had undergone TAVI and were assessed using the Mini Mental State Examination before and 6 months after the procedure. Cognitive deterioration or improvement was…
When to Intervene a Symptomatic Carotid Stenosis?
Guidelines recommend that carotid endarterectomy be performed within two weeks of stroke in patients with symptomatic carotid stenosis. Because a Swedish registry study showed patients treated within the first days after a transient ischemic attack or stroke are at increased risk of death and perioperatory stroke, this study aims at verifying this risk in…
Cerebral Protection in TAVR: Studies Presented at London Valves
SENTINEL One of the new devices assessed at London Valves was Sentinel, which is made up of two independent filters. The larger filter is deployed in the brachiocephalic trunk, and the smaller filter is deployed in the left common carotid artery. The study included 22 patients and the device was deployed successfully in 20 of them…
Carotid PCI at Long Term: Effective in Stroke Prevention?
There are no data outside controlled studies, neither are there long term outcomes, on carotid artery stenting. This study was designed to assess the long term effectiveness of carotid stenting to prevent strokes in a large number of real life patients. This registry included prospective data with a strict follow up protocol on 901…