TCT-21 Utility of Cerebral Embolic Protection in Transcaval Transcatheter Aortic Valve Replacement

Document Type

Conference Proceeding

Publication Date

10-28-2025

Publication Title

J Am Coll Cardiol

Abstract

Background: The utility of cerebral embolic protection (CEP) during alternative access TAVR is unclear. This study examines stroke rate in transcaval TAVR performed with and without CEP. Methods: This is a retrospective cohort study of 196 patients who underwent successful transcaval TAVR at Henry Ford Hospital from 2013-2025. Baseline characteristics and CEP use were obtained through review of electronic medical records. Peri-procedural stroke was confirmed with cerebral imaging. Results: Among 198 patients, 75 (37.9%) were male, with a mean age of 78.1 ± 9.3 years and an average STS mortality score of 7.39 ± 11.6. A history of prior stroke was present in 18 patients (9.09%). The overall post-TAVR stroke rate in the cohort was 2.02%. Stroke occurred in 1 of 59 patients (1.69%) who received CEP and 3 of 139 patients (2.16%) without CEP. CEP was associated with a nonsignificant reduction in stroke risk (RR 0.78; 95% CI, 0.08–7.49; p=1.00). The observed rate of periprocedural stroke in this cohort was not significantly different from contemporary standard access TAVR (RR 1.30; p=0.56). [Formula presented] Conclusion: CEP use was associated with a nonsignificant reduction in stroke risk, with event rates comparable to those reported in larger transfemoral studies and meta-analyses. The event rate did not differ significantly from contemporary rates for standard access TAVR. While limited by sample size and event frequency, this study represents, to our knowledge, the largest single-center description of stroke rate following transcaval TAVR. Larger studies are needed to better define the role of CEP in alternative access TAVR. Categories: ENDOVASCULAR: Stroke, Stroke Prevention, Carotid Intervention

Volume

86

Issue

17

First Page

B15

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