Stroke remains a devastating complication of transcatheter aortic valve replacement (TAVR), with the incidence of clinically apparent stroke seemingly fixed at around 3% despite TAVR's significant evolution during the past decade. Embolic showers of debris (calcium, atheroma, valve material, foreign material) are captured in the majority of patients who have TAVR using a filter-based cerebral embolic protection device (CEPD). Additionally, in systematic brain imaging studies, the majority of patients receiving TAVR exhibit new cerebral lesions. Mechanistic studies have shown reductions in the volume of new cerebral lesions using CEPDs, yet the first randomised trial powered for periprocedural stroke within 72 hours of a transfemoral TAVR failed to meet its primary endpoint of showing superiority of the SENTINEL CEPD. The present review summarises the clinicopathological rationale for the development of CEPDs, the evidence behind these devices to date and the emerging recognition of cerebral embolisation in many non-TAVR transcatheter procedures. Given the uniqueness of each of the various CEPDs under development, specific trials tailored to their designs will need to be undertaken to broaden the CEPD field, in addition to evaluating the role of CEPD in non-TAVR transcatheter heart interventions. Importantly, the cost-effectiveness of these devices will require assessment to broaden the adoption of CEPDs globally.

中文翻译：

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经导管心脏介入治疗期间的脑栓塞保护。

中风仍然是经导管主动脉瓣置换术 (TAVR) 的破坏性并发症，尽管 TAVR 在过去十年中取得了显着进展，但临床上明显的中风发生率似乎固定在 3% 左右。大多数接受 TAVR 的患者使用基于过滤器的脑栓塞保护装置 (CEPD) 捕获碎片（钙、动脉粥样硬化、瓣膜材料、异物）的栓塞簇。此外，在系统脑成像研究中，大多数接受 TAVR 的患者表现出新的脑损伤。机制研究表明，使用 CEPD 可以减少新脑损伤的体积，但第一个针对经股 TAVR 72 小时内围手术期卒中的随机试验未能达到显示 SENTINEL CEPD 优越性的主要终点。本综述总结了 CEPD 开发的临床病理学原理、迄今为止这些设备背后的证据以及许多非 TAVR 经导管手术中对脑栓塞的新认识。鉴于正在开发的各种 CEPD 的独特性，除了评估 CEPD 在非 TAVR 经导管心脏介入治疗中的作用之外，还需要进行针对其设计的具体试验，以扩大 CEPD 领域。重要的是，需要对这些设备的成本效益进行评估，以扩大 CEPD 在全球的采用。