{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:24:36Z","timestamp":1787063076209,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      Transcatheter aortic valve replacement (TAVR) is widely used to treat severe aortic stenosis; however, periprocedural stroke remains a significant concern. This systematic review and meta\u2010analysis evaluate whether the use of cerebral embolic protection devices (CEPDs) during TAVR reduces the risk of stroke and other complications. To conduct a network meta\u2010analysis of relevant trials to assess the efficacy of CEPDs currently used in TAVR. PubMed, Embase, and Scopus were systematically searched through April 2025 to identify studies comparing TAVR performed with and without CEPDs. Primary outcomes included stroke, all\u2010cause mortality, major bleeding, and major vascular complications. Data were analyzed using RevMan (Version 5.4.1). A random\u2010effects model was used for all analyses, applying the Mantel\u2212Haenszel method for dichotomous outcomes, reported as risk ratios with 95% confidence intervals. Funnel plots were used to assess publication bias. Twenty\u2010four studies (9 randomized controlled trials and 15 observational studies), including a total of 437,487 patients (59,274 with CEPD and 384,213 without), were included in the analysis. The mean patient age was 80 years, and 46.4% were female. Compared to patients undergoing TAVR without protection, those receiving CEPDs had significantly lower risks of stroke (RR\u2009=\u20090.70; 95% CI: 0.60\u20130.82;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), all\u2010cause mortality (RR\u2009=\u20090.69; 95% CI: 0.50\u20130.93;\n                      <jats:italic>p\u2009<\/jats:italic>\n                      =\u20090.02), disabling stroke (RR\u2009=\u20090.44; 95% CI: 0.26\u20130.75;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), acute kidney injury (RR\u2009=\u20090.84; 95% CI: 0.79\u20130.89;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.00001), and 30\u2010day readmission (RR\u2009=\u20090.75; 95% CI: 0.60\u20130.95;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). A reduction in major bleeding was also observed (RR\u2009=\u20090.83; 95% CI: 0.59\u20131.17), although this did not reach statistical significance (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.29). No significant differences were found between groups in terms of major vascular complications, transient ischemic attack (TIA), new pacemaker implantation, or delirium. The use of CEPDs during TAVR is associated with reduced risks of stroke, disabling stroke, acute kidney injury, and 30\u2010day readmission. However, discrepancies between randomized and observational studies warrant cautious interpretation. Further research is needed to clarify the benefits and evaluate the cost\u2010effectiveness of CEPD implementation in routine clinical practice.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70146","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T12:09:52Z","timestamp":1757074192000},"page":"2996-3007","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Efficacy of Cerebral Embolic Protection Device in Transcatheter Aortic Valve Replacement: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9236-0822","authenticated-orcid":false,"given":"Sufyan","family":"Shahid","sequence":"first","affiliation":[{"name":"Khawaja Muhammad Safdar Medical College Sialkot Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1514-1893","authenticated-orcid":false,"given":"Mahrosh","family":"Kasbati","sequence":"additional","affiliation":[{"name":"Dow University of Health Sciences Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1227-5840","authenticated-orcid":false,"given":"Samer Osama","family":"Adawi","sequence":"additional","affiliation":[{"name":"Al\u2010Quds University Jerusalem Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2005-9059","authenticated-orcid":false,"given":"Saniya","family":"Ishtiaq","sequence":"additional","affiliation":[{"name":"Rawalpindi Medical University Rawalpindi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0197-4264","authenticated-orcid":false,"given":"Muhammad","family":"Osama","sequence":"additional","affiliation":[{"name":"Hayatabad Medical Complex Peshawar Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2597-9265","authenticated-orcid":false,"given":"Syed Mohamin Abbas","family":"Shah","sequence":"additional","affiliation":[{"name":"King Edward Medical University Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8047-7270","authenticated-orcid":false,"given":"Muneeb","family":"Saifullah","sequence":"additional","affiliation":[{"name":"King Edward Medical University Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0539-1868","authenticated-orcid":false,"given":"Syed","family":"Ali","sequence":"additional","affiliation":[{"name":"Oklahoma Heart Hospital Oklahoma City Oklahoma USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raheel","family":"Ahmed","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iftikhar Ali","family":"Ch","sequence":"additional","affiliation":[{"name":"South Oklahoma Heart Research Oklahoma City Oklahoma USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salman","family":"Khalid","sequence":"additional","affiliation":[{"name":"Oklahoma Heart Hospital Oklahoma City Oklahoma USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naeem Khan","family":"Tahirkheli","sequence":"additional","affiliation":[{"name":"Oklahoma Heart Hospital Oklahoma City Oklahoma USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"F. 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D.Prendergast \u201cTechnical Aspects of Transcatheter Aortic Valve Implantation (TAVI) \u201d Published 2016 https:\/\/www.escardio.org\/Journals\/E-Journal-of-Cardiology-Practice\/Volume-14\/technical-aspects-of-transcatheter-aortic-valve-implantation-tavi."},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1816885"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1202277"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.shj.2024.100353"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa2415120"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-023-03338-0"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jscai.2023.101031"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.10.023"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.015915"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.12.002"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2021.01.023"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.10302"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.4244\/eijv12i4a84"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0735-1097(98)00497-5"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14041045"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2011-300065"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2022.06.033"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1161\/circinterventions.123.013697"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2021.04.038"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.carrev.2024.04.003"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2008.169805"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.4244\/eij-d-23-00166"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2020.11.011"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13185471"},{"key":"e_1_2_11_27_1","unstructured":"\u201cEvaluation of Safety and Effectiveness of the EMBLOK EPS During TAVR \u201d Clinicaltrials.gov Published 2025 https:\/\/www.clinicaltrials.gov\/study\/NCT05295628."},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.09.1158"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70146","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T19:04:53Z","timestamp":1762283093000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.70146"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,5]]},"references-count":27,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1002\/ccd.70146"],"URL":"https:\/\/doi.org\/10.1002\/ccd.70146","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,5]]},"assertion":[{"value":"2025-06-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}