The association of cerebral embolic protection during transcatheter aortic valve replacement with periprocedural neurological outcomes.

INTRODUCTION: Cerebral Embolic Protection Devices (CEPs) have been designed to minimize the risk of periprocedural stroke. The clinical significance of these devices, however, is still under debate. We aimed to compare periprocedural neurological outcomes and mortality in patients undergoing transfemoral transcatheter aortic valve replacement (TF-TAVR) with vs. without CEP. METHODS: A single-center retrospective analysis of 1,101 patients undergoing transfemoral TAVR from August 2017 to May 2025 was performed. CEPs were used routinely at our institution whenever anatomically feasible beginning with October 2019. The primary outcome was defined as the incidence of ischemic stroke occurring within 3 days postoperatively. Secondary endpoints included transient ischemic attack (TIA) and delirium within 3 days and short-term all-cause mortality. RESULTS: Overall, 809 underwent TF-TAVR with CEP, while 292 were treated without. The primary endpoint of clinical ischemic stroke occurred less frequently in the CEP group (1.4% vs. 4.1%), and the group difference revealed a significant result in a univariable Cox regression analysis (p = 0.007). No clinically relevant differences were observed in the incidence of TIA (0.5% vs. 0.7%, p = 0.71) and postprocedural delirium (1.6% vs. 2.4%, p = 0.39). The 30-day mortality rate was numerically higher in the control group, but the difference did not reach statistical significance (1.9% vs. 3.9%, p = 0.06). CONCLUSION: The use of neuroprotection during TAVR was associated with a lower observed hazard of early periprocedural ischemic stroke in this unadjusted retrospective cohort.