Antiembolic cerebral protection in transcatheter aortic valve implantation: from large evidence-based data to clinical case

Kavteladze Z.A.; Ermolaev P.M.; Danilenko S.Yu.; Tkacheva O.N.

doi:https://doi.org/10.17116/hirurgia202511290

Kavteladze Z.A.

Petrovsky National Research Center of Surgery;
Pirogov Russian National Research Medical University

ORCID: 0000-0003-0617-2332

Ermolaev P.M.

Petrovsky National Research Center of Surgery;
Pirogov Russian National Research Medical University

ORCID: 0000-0001-6247-3872

Danilenko S.Yu.

Petrovsky National Research Center of Surgery;
Pirogov Russian National Research Medical University

ORCID: 0000-0002-0887-0946

Tkacheva O.N.

Pirogov Russian National Research Medical University

SPIN RSCI: 6129-5809
Scopus AuthorID: 6602941818
ResearcherID: M-4510-2014
ORCID: 0000-0002-4193-688X

Antiembolic cerebral protection in transcatheter aortic valve implantation: from large evidence-based data to clinical case

Authors:

Kavteladze Z.A., Ermolaev P.M., Danilenko S.Yu., Tkacheva O.N.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2025;(11‑2): 90‑96

DOI: 10.17116/hirurgia202511290

Read: 601 times

Contact the author

Table of contents

To cite this article:

Kavteladze ZA, Ermolaev PM, Danilenko SYu, Tkacheva ON. Antiembolic cerebral protection in transcatheter aortic valve implantation: from large evidence-based data to clinical case. Pirogov Russian Journal of Surgery. 2025;(11‑2):90‑96. (In Russ.)
https://doi.org/10.17116/hirurgia202511290

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

Recommended articles:

Prediction of restoration of functional activity of paretic limbs in patients who have suffered an ischemic stroke. Problems of Balneology, Physiotherapy and Exercise Therapy. 2025;(3):31-40

Approaches to medical rehabilitation of patients with post-stroke hemianopsia. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(8-2):20-25

Epileptogenesis and risk factors of symptomatic epileptic seizures in patients with acute cerebrovascular accidents. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(8-2):26-31

Effectiveness of “brain—computer” interfaces with biofeedback in the rehabilitation of cognitive impairment after a stroke. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(8-2):54-60

Features of speech rehabilitation in various types of post-stroke dysarthria. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(8-2):61-66

Sex and age characteristics of stroke risk factors in patients with type 2 diabetes mellitus. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(8-2):89-97

Experience of using peripheral magnetic stimulation to restore diaphragm function in hemiparetic patients after stroke. Problems of Balneology, Physiotherapy and Exercise Therapy. 2025;(4):5-13

Gliatilin in the Treatment of Cognitive Impairments Not Reaching the Level of Dementia: Meta-Analysis and Systematic Review. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(11):86-99

Surgical treatment of a patient with severe aortic stenosis and hereditary factor XI deficiency. Russian Cardiology Bulletin. 2025;(4):88-93

Distal protection in transcatheter aortic valve implantation: pros and cons. Choice of the patient or preferences of the clinic and surgeon?. Pirogov Russian Journal of Surgery. 2025;(11-2):12-19

Abstract:

The authors present TAVI in an 82-year-old patient. The feature was objective embolism in antiembolic protection device. The necessity of antiembolic protection systems during transcatheter aortic valve implantation is discussed. The paper suggests possible solutions, and expresses the authors’ opinion.

Keywords:

device for distal antiembolic protection

transcatheter aortic valve implantation

stroke

Authors:

Kavteladze Z.A.

Petrovsky National Research Center of Surgery;
Pirogov Russian National Research Medical University

ORCID: 0000-0003-0617-2332

Ermolaev P.M.

Petrovsky National Research Center of Surgery;
Pirogov Russian National Research Medical University

ORCID: 0000-0001-6247-3872

Danilenko S.Yu.

Petrovsky National Research Center of Surgery;
Pirogov Russian National Research Medical University

ORCID: 0000-0002-0887-0946

Tkacheva O.N.

Pirogov Russian National Research Medical University

SPIN RSCI: 6129-5809
Scopus AuthorID: 6602941818
ResearcherID: M-4510-2014
ORCID: 0000-0002-4193-688X

Received:

14.07.2025

Accepted:

25.08.2025

Close metadata

References:

Rouleau SG, Brady WJ, Koyfman A, Long B. Transcatheter aortic valve replacement complications: A narrative review for emergency clinicians. The American Journal of Emergency Medicine. 2022;56:77-86. https://doi.org/10.1016/j.ajem.2022.03.042
Borer JS, Herrold EM, Carter JN, Catanzaro DF, Supino PG. Cellular and molecular basis of remodeling in valvular heart diseases. Heart Failure Clinics. 2006;2(4):415-424. https://doi.org/10.1016/j.hfc.2007.02.001
Thaden JJ, Nkomo VT, Enriquez-Sarano M. The global burden of aortic stenosis. Progress in Cardiovascular Diseases. 2014;56(6):565-571. https://doi.org/10.1016/j.pcad.2014.02.006
Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017;135(10):e146-e603. https://doi.org/10.1161/CIR.0000000000000485
Kavteladze ZA, Ermolaev PM, Danilenko SYu, Nadaraya VM. Cerebral protection in transcatheter aortic valve implantation. Pirogov Russian Journal of Surgery. 2024;(12-2):150-158. (In Russ.). https://doi.org/10.17116/hirurgia2024122150
Winter MP, Bartko P, Hofer F, Zbiral M, Burger A, Ghanim B, Kastner J, Lang IM, Mascherbauer J, Hengstenberg C, Goliasch G. Evolution of outcome and complications in TAVR: a meta-analysis of observational and randomized studies. Scientific Reports. 2020;10(1):15568. https://doi.org/10.1038/s41598-020-72453-1
Lansky AJ, Brown D, Pena C, Pietras CG, Parise H, Ng VG, Meller S, Abrams KJ, Cleman M, Margolis P, Petrossian G, Brickman AM, Voros S, Moses J, Forrest JK. Neurologic Complications of Unprotected Transcatheter Aortic Valve Implantation (from the Neuro-TAVI Trial). The American Journal of Cardiology. 2016;118(10):1519-1526. https://doi.org/10.1016/j.amjcard.2016.08.013
Kapadia SR, Kodali S, Makkar R, Mehran R, Lazar RM, Zivadinov R, Dwyer MG, Jilaihawi H, Virmani R, Anwaruddin S, Thourani VH, Nazif T, Mangner N, Woitek F, Krishnaswamy A, Mick S, Chakravarty T, Nakamura M, McCabe JM, Satler L, Zajarias A, Szeto WY, Svensson L, Alu MC, White RM, Kraemer C, Parhizgar A, Leon MB, Linke A; SENTINEL Trial Investigators. Protection Against Cerebral Embolism During Transcatheter Aortic Valve Replacement. The Journal of the American College of Cardiology. 2017;69(4):367-377. https://doi.org/10.1016/j.jacc.2016.10.023
Ghanem A, Müller A, Nähle CP, Kocurek J, Werner N, Hammerstingl C, Schild HH, Schwab JO, Mellert F, Fimmers R, Nickenig G, Thomas D. Risk and fate of cerebral embolism after transfemoral aortic valve implantation: a prospective pilot study with diffusion-weighted magnetic resonance imaging. The Journal of the American College of Cardiology. 2010;55(14):1427-1432. https://doi.org/10.1016/j.jacc.2009.12.026
Arnold M, Schulz-Heise S, Achenbach S, Ott S, Dörfler A, Ropers D, Feyrer R, Einhaus F, Loders S, Mahmoud F, Roerick O, Daniel WG, Weyand M, Ensminger SM, Ludwig J. Embolic cerebral insults after transapical aortic valve implantation detected by magnetic resonance imaging. JACC: Cardiovascular Interventions. 2010;3(11):1126-1132. https://doi.org/10.1016/j.jcin.2010.09.008
Kahlert P, Knipp SC, Schlamann M, Thielmann M, Al-Rashid F, Weber M, Johansson U, Wendt D, Jakob HG, Forsting M, Sack S, Erbel R, Eggebrecht H. Silent and apparent cerebral ischemia after percutaneous transfemoral aortic valve implantation: a diffusion-weighted magnetic resonance imaging study. Circulation. 2010;121(7):870-878. https://doi.org/10.1161/CIRCULATIONAHA.109.855866
Kapadia S, Agarwal S, Miller DC, Webb JG, Mack M, Ellis S, Herrmann HC, Pichard AD, Tuzcu EM, Svensson LG, Smith CR, Rajeswaran J, Ehrlinger J, Kodali S, Makkar R, Thourani VH, Blackstone EH, Leon MB. Insights Into Timing, Risk Factors, and Outcomes of Stroke and Transient Ischemic Attack After Transcatheter Aortic Valve Replacement in the PARTNER Trial (Placement of Aortic Transcatheter Valves). Circulation: Cardiovascular Interventions. 2016;9(9):e002981. https://doi.org/10.1161/CIRCINTERVENTIONS.115.002981
Muralidharan A, Thiagarajan K, Van Ham R, Gleason TG, Mulukutla S, Schindler JT, Jeevanantham V, Thirumala PD. Meta-Analysis of Perioperative Stroke and Mortality in Transcatheter Aortic Valve Implantation. The American Journal of Cardiology. 2016;118(7):1031-1045. https://doi.org/10.1016/j.amjcard.2016.07.011
Ahmad Y, Howard JP. Meta-Analysis of Usefulness of Cerebral Embolic Protection During Transcatheter Aortic Valve Implantation. The American Journal of Cardiology. 2021;146:69-73. https://doi.org/10.1016/j.amjcard.2021.01.023
Makkar RR, Gupta A, Waggoner TE, Horr S, Karha J, Satler L, Stoler RC, Alvarez J, Sakhuja R, MacDonald L, Modolo R, Leon MB, Linke A, Kapadia SR. Cerebral Embolic Protection by Geographic Region: A Post Hoc Analysis of the PROTECTED TAVR Randomized Clinical Trial. JAMA Cardiology. 2025;10(1):17-24. https://doi.org/10.1001/jamacardio.2024.4278
Kapadia SR, Makkar R, Leon M, Abdel-Wahab M, Waggoner T, Massberg S, Rottbauer W, Horr S, Sondergaard L, Karha J, Gooley R, Satler L, Stoler RC, Messé SR, Baron SJ, Seeger J, Kodali S, Krishnaswamy A, Thourani VH, Harrington K, Pocock S, Modolo R, Allocco DJ, Meredith IT, Linke A; PROTECTED TAVR Investigators. Cerebral Embolic Protection during Transcatheter Aortic-Valve Replacement. The New England Journal of Medicine. 2022;387(14):1253-1263. https://doi.org/10.1056/NEJMoa2204961
Kharbanda RK, Perkins AD, Kennedy J, Banning AP, Baumbach A, Blackman DJ, Dodd M, Evans R, Hildick-Smith D, Jamal Z, Ludman P, Palmer S, Stables R, Clayton T. Routine cerebral embolic protection in transcatheter aortic valve implantation: rationale and design of the randomised British Heart Foundation PROTECT-TAVI trial. EuroIntervention. 2023;18(17):1428-1435. https://doi.org/10.4244/EIJ-D-22-00713
Kharbanda R, Kapadia S. SENTINEL PROTECTION: A Global Prospective Meta-Analysis of the PROTECTED TAVR and BHF PROTECT-TAVI Studies. PROSPERO 2022 CRD42022324160. Accessed May 24, 2025. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022324160
Kharbanda R. Meta-Analysis of Individual Patient Data from the PROTECTED TAVR and BHF PROTECT-TAVI Trials. Major Late Breaking Trials session, EuroPCR 2025. Paris, France; 2025. Accessed May 24, 2025. https://www.pcronline.com/News/PCR-Press-Releases/2025/EuroPCR-2025-Meta-Analysis-of-Individual-Patient-Data-from-the-PROTECTED-TAVR-and-BHF-PROTECT-TAVI-Trials
Butala NM, Kapadia SR, Secemsky EA, Gallup D, Kosinski AS, Vemulapalli S, Messenger JC, Yeh RW, Cohen DJ. Impact of Cerebral Embolic Protection Devices on Disabling Stroke After TAVR: Updated Results From the STS/ACC TVT Registry. Circulation: Cardiovascular Interventions. 2024;17(9):e013697. https://doi.org/10.1161/CIRCINTERVENTIONS.123.013697
Bonnet M, Maxo L, Lohse T, Mangin L, Courand PY, Ricard C, Bouali A, Boussel L, Aktaa S, Ali N, Gerelli S, Lantelme P, Harbaoui B. Association Between Aortic Wall Thrombus and Thromboembolic Events After Transfemoral Transcatheter Aortic Valve Replacement. JACC: Cardiovascular Interventions. 2024;17(14):1680-1690. https://doi.org/10.1016/j.jcin.2024.05.033
Vlastra W, Jimenez-Quevedo P, Tchétché D, Chandrasekhar J, de Brito FS Jr, Barbanti M, Kornowski R, Latib A, D’Onofrio A, Ribichini F, Baan J, Tijssen JGP, De la Torre Hernandez JM, Dumonteil N, Sarmento-Leite R, Sartori S, Rosato S, Tarantini G, Lunardi M, Orvin K, Pagnesi M, Hernandez-Antolin R, Modine T, Dangas G, Mehran R, Piek JJ, Delewi R. Predictors, Incidence, and Outcomes of Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation Complicated by Stroke. Circulation: Cardiovascular Interventions. 2019;12(3):e007546. https://doi.org/10.1161/CIRCINTERVENTIONS.118.007546
Bjursten H, Norrving B, Ragnarsson S. Late stroke after transcatheter aortic valve replacement: a nationwide study. Scientific Reports. 2021;11(1):9593. https://doi.org/10.1038/s41598-021-89217-0
Berkovitch A, Segev A, Maor E, Sedaghat A, Finkelstein A, Saccocci M, Kornowski R, Latib A, De La Torre Hernandez JM, Søndergaard L, Mylotte D, Van Royen N, Zaman AG, Robert P, Sinning JM, Steinvil A, Maisano F, Orvin K, Iannopollo G, Lee DH, De Backer O, Mercanti F, van der Wulp K, Shome J, Tchétché D, Barbash IM. Clinical Predictors for Procedural Stroke and Implications for Embolic Protection Devices during TAVR: Results from the Multicenter Transcatheter Aortic Valve Replacement In-Hospital Stroke (TASK) Study. Journal of Personalized Medicine. 2022;12(7):1056. https://doi.org/10.3390/jpm12071056
Kavteladze ZA, Ermolaev PM, Danilenko SYu, Nadaraya VM. History of anti-embolic protection in cardiac surgery. Pirogov Russian Journal of Surgery. 2024;(12-2):139-149. (In Russ.). https://doi.org/10.17116/hirurgia2024122139
Mikhailova AA, Korchazhkina NB, Kotenko KV, Koneva ES. Experience in the application of robotic biomechanical medical rehabilitation techniques in patients after acute cerebrovascular accident. Problems of Balneology, Physiotherapy and Exercise Therapy. 2021;98(3-2):127-128. (In Russ.).
Korchazhkina NB, Mikhailova AA, Reshetova IV, Dimova OV, Kotenko KV. Modern approaches to developing a system of valid methods for monitoring individual health and maintaining active longevity. Problems of Balneology, Physiotherapy and Exercise Therapy. 2023;100(6):6-13. (In Russ.). https://doi.org/10.17116/kurort20231000616
Korchazhkina NB, Mikhailova AA, Badimova AV, Reshetova IV, Dymova OV, Eremin II, Kotenko KV. Methods and markers of prenosological diagnosis and monitoring of individual health and maintenance of active longevity. Problems of Balneology, Physiotherapy and Exercise Therapy. 2023;100(5-2):20-21. (In Russ.).
Kavteladze ZA, Ermolaev PM, Danilenko SYu. New devices for antiembolic protection during transcatheter heart interventions. Russian Journal of Endovascular Surgery. 2023;10(4): 382-403. (In Russ.). https://doi.org/10.24183/2409-4080-2023-10-4-382-403