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Background and Purpose
The use of embolic protection devices (EPD) may theoretically reduce the occurrence of cerebral embolic lesions during transcatheter aortic valve implantation (TAVI). Available evidence from single studies is quite inconclusive. The aim of the present meta-analysis was to assess the safety and efficacy profile of current EPD.
EMBASE, PubMed, Web of Science Core Collection, and the Cochrane Library were searched up to October 2017 for studies that evaluated patients undergoing TAVI with or without EPD. Endpoints of interest were 30-day mortality, 30-day stroke, the total number of new lesions, the ischemic volume per lesion, and the total volume of lesions.
Seven studies involving 725 patients were included. The EPD delivery success rate was reported in all studies and was achieved in 94.5% of patients. The use of EPD was not associated with significant differences in terms of 30-day mortality [OR 0.57 (0.19, 1.66), p=0.3] or stroke [OR 0.67 (0.35-1.29), p=0.23]. Moreover, no differences were detected with respect to the number of new lesions: [standardized mean difference −0.19; (−0.71 to 0.34); P=0.49]. The use of EPD was associated with a significantly smaller ischemic volume per lesion [standardized mean difference, −0.52; (−0.85 to −0.20); P=0.002] and smaller total volume of lesions [standardized mean difference, −0.23 (−0.42 to −0.03), P=0.02].
The use of EPD is not associated with a reduced rate of stroke, mortality and new ischemic cerebral lesions. The use of EPD during TAVI is associated with smaller volume of ischemic lesions and smaller total volume of ischemic lesions.