Kaur Arpanjeet, Dhaliwal Arshdeep S, Sohal Sumit, Gwon Yeongjin, Gupta Soumya, Bhatia Kirtipal, Dominguez Abel Casso, Basman Craig, Tamis-Holland Jacqueline
Department of Medicine Icahn School of Medicine at Mount Sinai Morningside/West- New York New York NY.
Population Health Science and Policy Icahn School of Medicine at Mount Sinai- New York New York NY.
J Am Heart Assoc. 2024 Feb 6;13(3):e030587. doi: 10.1161/JAHA.123.030587. Epub 2024 Jan 19.
Cerebral embolic protection devices (CEPD) capture embolic material in an attempt to reduce ischemic brain injury during transcatheter aortic valve replacement. Prior reports have indicated mixed results regarding the benefits of these devices. With new data emerging, we performed an updated meta-analysis examining the effect of CEPD during transcatheter aortic valve replacement on various clinical, neurological, and safety parameters.
A comprehensive review of electronic databases was performed comparing CEPD and no-CEPD in transcatheter aortic valve replacement. Primary clinical outcome was all-cause stroke. Secondary clinical outcomes were disabling stroke and all-cause mortality. Neurological outcomes included worsening of the National Institutes of Health Stroke Scale score, Montreal Cognitive Assessment score from baseline at discharge, presence of new ischemic lesions, and total lesion volume on neuroimaging. Safety outcomes included major or minor vascular complications and stage 2 or 3 acute kidney injury. Seven randomized controlled trials with 4016 patients met the inclusion criteria. There was no statistically significant difference in the primary clinical outcome of all-cause stroke; secondary clinical outcomes of disabling stroke, all-cause mortality, neurological outcomes of National Institutes of Health Stroke Scale score worsening, Montreal Cognitive Assessment worsening, presence of new ischemic lesions, or total lesion volume on diffusion-weighted magnetic resonance imaging between CEPD versus control groups. There was no statistically significant difference in major or minor vascular complications or stage 2 or 3 acute kidney injury between the groups.
The use of CEPD in transcatheter aortic valve replacement was not associated with a statistically significant reduction in the risk of clinical, neurological, and safety outcomes.
脑栓塞保护装置（CEPD）可捕获栓塞物质，以试图减少经导管主动脉瓣置换术期间的缺血性脑损伤。先前的报告显示这些装置的益处存在不同结果。随着新数据的出现，我们进行了一项更新的荟萃分析，以研究经导管主动脉瓣置换术期间CEPD对各种临床、神经学和安全性参数的影响。
对电子数据库进行了全面检索，比较经导管主动脉瓣置换术中使用CEPD与不使用CEPD的情况。主要临床结局是全因性卒中。次要临床结局是致残性卒中和全因性死亡。神经学结局包括美国国立卫生研究院卒中量表评分恶化、出院时蒙特利尔认知评估评分较基线的变化、新缺血性病变的出现以及神经影像学上的总病变体积。安全性结局包括严重或轻微血管并发症以及2期或3期急性肾损伤。七项随机对照试验纳入了4016例患者，符合纳入标准。在全因性卒中这一主要临床结局方面，CEPD组与对照组之间无统计学显著差异；在致残性卒中、全因性死亡等次要临床结局，美国国立卫生研究院卒中量表评分恶化、蒙特利尔认知评估恶化等神经学结局，以及扩散加权磁共振成像上新缺血性病变的出现或总病变体积方面，两组之间也无统计学显著差异。两组在严重或轻微血管并发症或2期或3期急性肾损伤方面无统计学显著差异。
经导管主动脉瓣置换术中使用CEPD与临床、神经学和安全性结局风险的统计学显著降低无关。
