{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T19:30:37Z","timestamp":1786476637649,"version":"build-2736575974"},"reference-count":32,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Transcatheter aortic valve implantation (TAVI) is associated with procedure\u2010related stroke. Cerebral embolic protection devices (CEPDs) are designed to reduce the risk of embolic debris reaching the brain; however, the evidence supporting their efficacy remains controversial. We aim to evaluate the efficacy and safety of CEPDs in patients undergoing TAVI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Major databases were systematically searched up to April 2025. Only randomized controlled trials (RCTs) were included and critically appraised using the Cochrane Risk of Bias (ROB\u20102) tool. We calculated risk ratios (RRs) with the 95% confidence intervals for the outcomes, and trial sequential analysis (TSA) was conducted to reduce the risk of false\u2010positive results due to random errors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eight RCTs (11,589 patients) were analyzed. No significant difference was observed in overall stroke incidence between CEPD and control groups (0.92 (95% CI: 0.75\u20131.14;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.40, I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%), including disabling and non\u2010disabling strokes. Device\u2010specific analyses showed a non\u2010significant reduction in disabling stroke with the Sentinel device. All\u2010cause mortality, transient ischemic attacks, bleeding, acute kidney injury, delirium, and pacemaker implantation rates were similar between groups. CEPD use was linked to a transient improvement in cognitive function (MoCA scores) at 2\u20135 days post\u2010TAVI, but this effect was not sustained at later follow\u2010ups. TSA indicated that current evidence is insufficient to definitively refute CEPD efficacy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CEPDs show no significant reduction in overall, disabling, or non\u2010disabling stroke, nor in all\u2010cause mortality post\u2010TAVI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>This meta\u2010analysis was registered on PROSPERO. No.: CRD420251026208.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/clc.70309","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T08:40:11Z","timestamp":1776933611000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cerebral Embolic Protection Devices (CEPDs) During Transcatheter Aortic Valve Implantation (TAVI): A Meta\u2010Analysis of Randomized Controlled Trials"],"prefix":"10.1002","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4030-942X","authenticated-orcid":false,"given":"Mohamed Ibrahim","family":"Gbreel","sequence":"first","affiliation":[{"name":"Faculty of Medicine October 6 University Giza Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8445-778X","authenticated-orcid":false,"given":"Ahmed Samy","family":"Badran","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Ain Shams University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwa","family":"Hassan","sequence":"additional","affiliation":[{"name":"Theodor Bilharz Research Institute Giza Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Balata","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Hospital Rostock Rostock Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1008232"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivaf308"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw225"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1103510"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.7525"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2015.01.020"},{"key":"e_1_2_14_8_1","doi-asserted-by":"crossref","unstructured":"Wendt D.Kleinbongard P.Knipp et al. Intraaortic Protection From Embolization in Patients Undergoing Transaortic Transcatheter Aortic Valve Implantation. 2015.","DOI":"10.1016\/j.athoracsur.2015.03.119"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2415120"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781119536604"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.5195\/jmla.2017.111"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.09.012"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.07.015"},{"key":"e_1_2_14_16_1","unstructured":"Copenhagen Trial Unit. Trial Sequential Analysis (TSA). 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