ArticleClinical research in cardiology : official journal of the German Cardiac Society2026
Cerebral embolic protection (CEP) during transcatheter aortic valve replacement (TAVR) is associated with a lower rate of stroke at a high-volume center.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCerebral embolic protection (CEP) reduces strokes during transcatheter aortic valve replacement (TAVR) but is not standard of care at most centers.
aimTo assess the impact of CEP use in real-world practice at a tertiary center using CEP as a standard of care during TAVR.
methodsIn-hospital outcome of 2173 patients was compared to 328 (13.1%) patients who could not receive CEP during TAVR due to anatomical or technical reasons. In a secondary analysis, adjusted stroke risk was compared using propensity score matching.
resultsNon-CEP patients had significantly higher Society of Thoracic Surgeons score for mortality (5.2 [interquartile range (IQR): 3.3-7.9] vs. 3.4% [IQR: 2.2-5.9], p < 0.01) and were more often female (54.0 vs. 46.4%, p = 0.01). Comorbidities such as coronary artery disease (63.4 vs. 61.7%, p = 0.54) and prior cardiac surgery (11.9 vs. 9.6%, p = 0.19) were equally frequent in both groups, whereas a history of prior stroke (16.2 vs. 11.7%, p = 0.02) was more frequent in non-CEP patients. Despite significantly longer procedure time in CEP patients (55.0 min [IQR: 46.0-66.0] vs. 53.0 min [43.0-63.3], p < 0.01), intraprocedural death (0 vs. 0.1%, p = 1.0), arrhythmia (11.9 vs. 11.9%, p = 0.99), and vascular access-site complications (5.5 vs. 4.3%, p = 0.32) were equally frequent. Although intraprocedural stroke occurred seldomly in both patient groups (0 vs. 0.3%, p = 1.0), in-hospital disabling stroke occurred more often in non-CEP patients (4.0 vs. 1.8%, p = 0.01). In the propensity score matched cohort, CEP use was associated with a significantly lower risk of all stroke (OR: 0.41, 95% CI: 0.22-0.77, p < 0.01) as well as disabling stroke (OR: 0.37, 95% CI: 0.18-0.78, p < 0.01).
conclusionAt a high-volume center using CEP as part of its standard of care during TAVR, CEP use was associated with a lower rate of in-hospital stroke. Especially those patients who could not receive CEP seemed to be at increased risk for stroke.
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