Stroke Rates and Clinical Outcomes After Transcaval Transcatheter Aortic Valve Replacement With and Without Central Embolic Protection: A Single-Center Experience.

Background: Alternate access transcatheter aortic valve replacement (TAVR) is associated with higher stroke rates. However, the use of cerebral embolic protection (CEP) in alternative access TAVR is not well defined. We sought to describe the 30-day stroke incidence and clinical outcomes in patients undergoing transcaval TAVR with and without CEP. Methods: We performed a single-center retrospective cohort study of 197 patients who underwent transcaval TAVR from 2014 to 2025. CEP, when anatomically feasible, was employed using the SENTINEL device (Boston Scientific) after its commercial availability in 2017. The primary outcome was 30-day stroke. Secondary outcomes included 30-day major adverse cardiac events (MACE-3 [defined as the composite of nonfatal myocardial infarction, stroke, and cardiac death]). Results: Of 197 patients, 59 received CEP and 138 did not. Baseline characteristics, including prior stroke and transient ischemic attack, were similar between groups. Overall, 30-day stroke was rare (2.54%) and similar between CEP and non-CEP patients (1.69% vs 2.9%, Conclusions: In the largest description of stroke rates in transcaval TAVR with and without CEP, 30-day stroke and MACE-3 events were similar with and without CEP use. A further study is warranted to describe the protective utility of CEP in high-risk TAVR cohorts.