经导管主动脉瓣置换术相关脑卒中及脑栓塞保护装置研究进展

New advances in stroke and cerebral embolism protection devices in transcatheter aortic valve replacement

脑卒中作为经导管主动脉瓣置换术(TAVR)最严重并发症之一,显著增加患者神经认知功能下降和死亡的风险。随着TAVR的适应证进一步扩展到外科低风险患者群体,脑卒中的防治至关重要。近年来多种脑栓塞保护装置(CEPD)被用于过滤或偏转去往脑循环的栓塞碎片,已成为预防脑卒中的一种选择,因此亟需了解CEPD在预防脑卒中的作用及适用群体,然而,目前TAVR相关脑卒中的风险因素以及常规使用CEPD的证据尚存在争议。本文就TAVR相关脑卒中及CEPD的研究证据进行综述,并概述了这一领域的最新进展。

Stroke is one of the most serious complications of transcatheter aortic valve replacement(TAVR),tremendously increasing mortality and the loss of neurocognitive function.Since TAVR is expected to further spread into lower-risk patient groups,there will be greater emphasis to obviate such serious complications.One possible technique for preventing stroke is using cerebral embolic protection devices(CEPDs).CEPDs are designed for capturing or deflecting emboli that are enter route to the brain and hence to protect the brain from embolism.Since this is a rapidly growing field with recent advances,and the impact of CEPD on preventing neurological events is still limited,there is an urgent need for understanding the role of CEPD in preventing clinically significant strokes.Although their clinical utilization is increasing,the risk factors for stroke related to TAVR and evidence for using CEPDs are not yet clear.In this review,we present an overview of the available literature on TAVR related stroke and CEPD,and outline recent advances within this field.