Iskander Mina, Jamil Yasser, Forrest John K, Madhavan Mahesh V, Makkar Raj, Leon Martin B, Lansky Alexandra, Ahmad Yousif
Yale School of Medicine, Yale University, New Haven, Connecticut, USA.
Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Struct Heart. 2023 Apr 17;7(4):100169. doi: 10.1016/j.shj.2023.100169. eCollection 2023 Jul.
Transcatheter aortic valve replacement (TAVR) is a treatment option for patients with symptomatic severe aortic stenosis across the entire spectrum of surgical risk. Recent trial data have led to the expansion of TAVR into lower-risk patients. With iterative technological advances and successive increases in procedural experience, the occurrence of complications following TAVR has declined. One of the most feared complications remains stroke, and patients consider stroke a worse outcome than death. There has therefore been great interest in strategies to mitigate the risk of stroke in patients undergoing TAVR. In this paper, we will discuss mechanisms and predictors of stroke after TAVR and describe the currently available cerebral embolic protection devices, including their design and relevant clinical studies pertaining to their use. We will also review the current overall evidence base for cerebral embolic protection during TAVR and ongoing randomized controlled trials. Finally, we will discuss our pragmatic recommendations for the use of cerebral embolic protection devices in patients undergoing TAVR.
经导管主动脉瓣置换术（TAVR）是一种针对具有症状性严重主动脉瓣狭窄且手术风险范围广泛的患者的治疗选择。近期的试验数据促使TAVR扩展至低风险患者。随着技术的不断进步以及手术经验的持续增加，TAVR术后并发症的发生率有所下降。最令人担忧的并发症之一仍然是中风，并且患者认为中风是比死亡更糟糕的结局。因此，人们对降低接受TAVR患者中风风险的策略产生了浓厚兴趣。在本文中，我们将讨论TAVR术后中风的机制和预测因素，并描述目前可用的脑栓塞保护装置，包括其设计以及与使用相关的临床研究。我们还将回顾目前关于TAVR期间脑栓塞保护的总体证据基础以及正在进行的随机对照试验。最后，我们将讨论对于接受TAVR患者使用脑栓塞保护装置的实用建议。
