Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Am J Cardiol. 2021 May 1;146:69-73. doi: 10.1016/j.amjcard.2021.01.023. Epub 2021 Feb 5.
One of the most feared complications of transcatheter aortic valve implantation (TAVI) is stroke, with increased mortality and disability observed in patients suffering a stroke after TAVI. There has been no significant decline in stroke rates seen over the last 5 years; attention has therefore been given to strategies for cerebral embolic protection. With the emergence of new randomized trial data, we sought to perform an updated systematic review and meta-analysis to examine the effect of cerebral embolic protection during TAVI both on clinical outcomes and on neuroimaging parameters. We performed a random-effects meta-analysis of randomized clinical trials of cerebral embolic protection during TAVI. The primary end point was the risk of stroke. The risk of stroke was not significantly different with the use of cerebral embolic protection: relative risk (RR) 0.88, 95% confidence interval (CI) 0.57 to 1.36, p = 0.566. Nor was there a significant reduction in the risk of disabling stroke, non-disabling stroke or death. There was no significant difference in total lesion volume on MRI with cerebral embolic protection: mean difference -74.94, 95% CI -174.31 to 24.4, p = 0.139. There was also not a significant difference in the number of new ischemic lesions on MRI: mean difference -2.15, 95% -5.25 to 0.96, p = 0.176, although there was significant heterogeneity for the neuroimaging outcomes. In conclusion, cerebral embolic protection during TAVI is safe but there is no evidence of a statistically significant benefit on clinical outcomes or neuroimaging parameters.
经导管主动脉瓣植入术（TAVI）后最令人恐惧的并发症之一是中风，中风患者的死亡率和残疾率增加。在过去的 5 年中，中风发生率没有明显下降；因此，人们关注的是脑保护策略。随着新的随机试验数据的出现，我们试图进行更新的系统评价和荟萃分析，以检查 TAVI 期间使用脑保护装置对临床结局和神经影像学参数的影响。我们对 TAVI 期间使用脑保护装置的随机临床试验进行了随机效应荟萃分析。主要终点是中风风险。使用脑保护装置并未显著降低中风风险：相对风险（RR）0.88，95%置信区间（CI）0.57 至 1.36，p = 0.566。使用脑保护装置也没有降低致残性中风、非致残性中风或死亡的风险。MRI 上使用脑保护装置后总病变体积无显著差异：平均差异-74.94，95%CI-174.31 至 24.4，p = 0.139。MRI 上新的缺血性病变数量也无显著差异：平均差异-2.15，95%CI-5.25 至 0.96，p = 0.176，尽管神经影像学结果存在显著异质性。总之，TAVI 期间使用脑保护装置是安全的，但在临床结局或神经影像学参数方面没有证据表明具有统计学意义的益处。
