Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement — Another Swing and a Miss

Outcomes after transcatheter aortic valve replacement (TAVR) continue to improve, but periprocedural stroke continues to occur in about 2% of patients, leading to substantial morbidity and financial costs. Cerebral embolic protection (CEP) devices have been shown to reliably capture debris during TAVR, but evidence of clinical benefit is limited. In the only previous large, randomized trial, the dual-filter Sentinel device did not reduce the primary endpoint of overall stroke incidence but showed a possible benefit for disabling stroke (NEJM JW Cardiol Sep 30 2022 and N Engl J Med 2022; 387:1253). Now, in a trial funded by the British Heart Foundation (ISRCTN16665769), investigators randomized 7635 patients (mean age, 81 years; 39% women) t…