{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T21:03:29Z","timestamp":1782939809792,"version":"3.54.5"},"reference-count":115,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T00:00:00Z","timestamp":1693180800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Intraprocedural stroke is a well-documented and feared potential risk of cardiovascular transcatheter procedures (TPs). Moreover, subclinical neurological events or covert central nervous system infarctions are concerns related to the development of dementia, future stroke, cognitive decline, and increased risk of mortality. Cerebral protection devices (CPDs) were developed to mitigate the risk of cardioembolic embolism during TPs. They are mechanical barriers designed to cover the ostium of the supra-aortic branches in the aortic arch, but newer devices are able to protect the descending aorta. CPDs have been mainly designed and tested to provide cerebral protection during transcatheter aortic valve replacement (TAVR), but their use in both Catheterization and Electrophysiology laboratories is rapidly increasing. CPDs have allowed us to perform procedures that were previously contraindicated due to high thromboembolic risk, such as in cases of intracardiac thrombosis identified at preprocedural assessment. However, several concerns related to their employment have to be defined. The selection of patients at high risk of thromboembolism is still a subjective choice of each center. The aim of this review is to update the evidence on the use of CPDs in either Cath labs or EP labs, providing an overview of their structural characteristics. Future perspectives focusing on their possible future employment are also discussed.<\/jats:p>","DOI":"10.3390\/life13091819","type":"journal-article","created":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T08:35:05Z","timestamp":1693298105000},"page":"1819","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Fighting Cardiac Thromboembolism during Transcatheter Procedures: An Update on the Use of Cerebral Protection Devices in Cath Labs and EP Labs"],"prefix":"10.3390","volume":"13","author":[{"given":"Alberto","family":"Preda","sequence":"first","affiliation":[{"name":"Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Montalto","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Galasso","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Munaf\u00f2","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Garofani","sequence":"additional","affiliation":[{"name":"Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Baroni","sequence":"additional","affiliation":[{"name":"Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Gigli","sequence":"additional","affiliation":[{"name":"Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Vargiu","sequence":"additional","affiliation":[{"name":"Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4375-5991","authenticated-orcid":false,"given":"Marisa","family":"Varrenti","sequence":"additional","affiliation":[{"name":"Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Colombo","sequence":"additional","affiliation":[{"name":"Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1603-6147","authenticated-orcid":false,"given":"Marco","family":"Carbonaro","sequence":"additional","affiliation":[{"name":"Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Della Rocca","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1090 Brussels, Belgium"},{"name":"Texas Cardiac Arrhythmia Institute, St. David\u2019s Medical Center, Austin, TX 78705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"Oreglia","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5775-1874","authenticated-orcid":false,"given":"Patrizio","family":"Mazzone","sequence":"additional","affiliation":[{"name":"Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3473-1058","authenticated-orcid":false,"given":"Fabrizio","family":"Guarracini","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2480","DOI":"10.1001\/jama.2021.2133","article-title":"Transcatheter Treatment of Valvular Heart Disease","volume":"325","author":"Davidson","year":"2021","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.4244\/EIJ-D-22-00070","article-title":"Transcatheter interventions for heart failure","volume":"18","author":"Latib","year":"2023","journal-title":"EuroIntervention"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Canfield, J., and Totary-Jain, H. (2018). 40 Years of Percutaneous Coronary Intervention: History and Future Directions. J. Pers. Med., 8.","DOI":"10.3390\/jpm8040033"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"I116","DOI":"10.1093\/eurheartj\/sum073","article-title":"Evolution of ablation techniques: From WPW to complex arrhythmias","volume":"9","author":"Wolpert","year":"2007","journal-title":"Eur. Hear. J. Suppl."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"W26","DOI":"10.4244\/EIJV11SWA7","article-title":"Stroke prevention in valvular heart disease: From the procedure to long-term management","volume":"14","author":"Giustino","year":"2015","journal-title":"EuroIntervention"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1772","DOI":"10.1016\/j.jacc.2022.08.770","article-title":"Trends in the Incidence and Fatality of Peripercutaneous Coronary Intervention Stroke","volume":"80","author":"Carrena","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1161\/STROKEAHA.122.041057","article-title":"Early Stroke and Mortality after Percutaneous Left Atrial Appendage Occlusion in Patients with Atrial Fibrillation","volume":"54","author":"Kogan","year":"2023","journal-title":"Stroke"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"630090","DOI":"10.3389\/fcvm.2021.630090","article-title":"Clinical Safety and Efficacy of Ablation for Atrial Fibrillation Patients with a History of Stroke","volume":"8","author":"Song","year":"2021","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Ma, V.Y., Chan, L., and Carruthers, K.J. (2014). Incidence, Prevalence, Costs, and Impact on Disability of Common Conditions Requiring Rehabilitation in the United States: Stroke, Spinal Cord Injury, Traumatic Brain Injury, Multiple Sclerosis, Osteoarthritis, Rheumatoid Arthritis, Limb Loss, and Back Pain. Arch. Phys. Med. Rehabil., 95.","DOI":"10.1016\/j.apmr.2013.10.032"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1016\/j.amjcard.2016.08.013","article-title":"Neurologic Complications of Unprotected Transcatheter Aortic Valve Implantation (from the Neuro-TAVI Trial)","volume":"118","author":"Lansky","year":"2016","journal-title":"Am. J. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1056\/NEJMoa022066","article-title":"Silent Brain Infarcts and the Risk of Dementia and Cognitive Decline","volume":"348","author":"Vermeer","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.jstrokecerebrovasdis.2005.11.001","article-title":"Silent Brain Infarction and Subcortical White Matter Lesions Increase the Risk of Stroke and Mortality: A Prospective Cohort Study","volume":"15","author":"Bokura","year":"2006","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1111\/j.1540-8167.2005.40686.x","article-title":"Intracardiac Ultrasound Detection of Thrombus on Transseptal Sheath: Incidence, Treatment, and Prevention","volume":"16","author":"Maleki","year":"2005","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1038\/modpathol.2010.74","article-title":"Hydrophilic polymer emboli: An under-recognized iatrogenic cause of ischemia and infarct","volume":"23","author":"Mehta","year":"2010","journal-title":"Mod. Pathol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.jvir.2006.12.733","article-title":"Thrombus Formation at the Surface of Guide-Wire Models: Effects of Heparin-releasing or Heparin-exposing Surface Coatings","volume":"18","author":"Aldenhoff","year":"2007","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.jcin.2015.09.039","article-title":"Cerebral Protection During MitraClip Implantation: Initial Experience at 2 Centers","volume":"9","author":"Frerker","year":"2016","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s10840-010-9531-3","article-title":"Particle formation and risk of embolization during transseptal catheterization: Comparison of standard transseptal needles and a new radiofrequency transseptal needle","volume":"30","author":"Feld","year":"2011","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e009005","DOI":"10.1161\/JAHA.118.009005","article-title":"Cerebral Protection during Catheter Ablation of Ventricular Tachycardia in Patients with Ischemic Heart Disease","volume":"7","author":"Heeger","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.jcin.2020.09.047","article-title":"The Use and Outcomes of Cerebral Protection Devices for Patients Undergoing Transfemoral Transcatheter Aortic Valve Replacement in Clinical Practice","volume":"14","author":"Stachon","year":"2021","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.amjcard.2021.01.023","article-title":"Meta-Analysis of Usefulness of Cerebral Embolic Protection during Transcatheter Aortic Valve Implantation","volume":"146","author":"Ahmad","year":"2021","journal-title":"Am. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"101127","DOI":"10.1016\/j.cpcardiol.2022.101127","article-title":"Cerebral Embolic Protection during Transcatheter Aortic Valve Implantation: Updated Systematic Review and Meta-Analysis","volume":"48","author":"Zahid","year":"2023","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"B131","DOI":"10.1016\/j.jacc.2022.08.383","article-title":"TCT-327 Clinical and Radiographic Measures of Stroke-Related Outcomes with Cerebral Embolic Protection Devices during TAVR: A Meta-Analysis","volume":"80","author":"Kaur","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1001\/jama.2016.10302","article-title":"Effect of a Cerebral Protection Device on Brain Lesions following Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis: The CLEAN-TAVI Randomized Clinical Trial","volume":"316","author":"Haussig","year":"2016","journal-title":"AMA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.jacep.2019.11.017","article-title":"Feasibility of Left Atrial Appendage Occlusion in Left Atrial Appendage Thrombus: A Systematic Review","volume":"6","author":"Sharma","year":"2020","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e02","DOI":"10.15420\/usc.2022.12","article-title":"Cerebral Embolic Protection Devices: Current State of the Art","volume":"17","author":"Agrawal","year":"2023","journal-title":"US Cardiol. Rev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2673","DOI":"10.1016\/j.jcmg.2020.02.036","article-title":"3-Dimensional CT Planning for Cerebral Embolic Protection in Structural Interventions","volume":"13","author":"Kang","year":"2020","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"584","DOI":"10.21037\/atm.2019.09.25","article-title":"Cerebral protection devices for transcatheter aortic valve replacement","volume":"7","author":"Pascual","year":"2019","journal-title":"Ann. Transl. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e003284","DOI":"10.1161\/CIRCINTERVENTIONS.115.003284","article-title":"Embolic Protection Devices in Transcatheter Aortic Valve Replacement","volume":"9","author":"Steinvil","year":"2016","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"150","DOI":"10.3389\/fcvm.2018.00150","article-title":"The Role of Cerebral Embolic Protection Devices During Transcatheter Aortic Valve Replacement","volume":"5","author":"Demir","year":"2018","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1016\/j.jcin.2014.04.019","article-title":"Feasibility and Exploratory Efficacy Evaluation of the Embrella Embolic Deflector System for the Prevention of Cerebral Emboli in Patients Undergoing Transcatheter Aortic Valve Replacement","volume":"7","author":"Kahlert","year":"2014","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"S3604","DOI":"10.21037\/jtd.2018.09.62","article-title":"Cerebral embolic protection devices during transcatheter aortic valve implantation: Clinical versus silent embolism","volume":"10","author":"Armijo","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1111\/joic.12573","article-title":"Cerebral embolic protection systems for transcatheter aortic valve replacement","volume":"31","author":"Gasior","year":"2018","journal-title":"J. Interv. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"75","DOI":"10.4244\/EIJY15M04_01","article-title":"Safety and performance of a novel embolic deflection device in patients undergoing transcatheter aortic valve replacement: Results from the DEFLECT I study","volume":"11","author":"Baumbach","year":"2015","journal-title":"EuroIntervention"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1002\/ccd.26566","article-title":"TriGuard\u2122 HDH embolic deflection device for cerebral protection during transcatheter aortic valve replacement","volume":"89","author":"Samim","year":"2017","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.jacep.2022.01.001","article-title":"Use of Cerebral Protection Device in Patients Undergoing Ventricular Tachycardia Catheter Ablation","volume":"8","author":"Zachariah","year":"2022","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Berg, J., Preda, A., Fierro, N., Marzi, A., Radinovic, A., Della Bella, P., and Mazzone, P. (2023). A Referral Center Experience with Cerebral Protection Devices: Challenging Cardiac Thrombus in the EP Lab. J. Clin. Med., 12.","DOI":"10.3390\/jcm12041549"},{"key":"ref_37","first-page":"1","article-title":"First-in-Human Use of the Next-generation ProtEmbo Cerebral Embolic Protection System During Transcatheter Aortic Valve-in-valve Implantation","volume":"16","author":"Jagielak","year":"2021","journal-title":"Interv. Cardiol. Rev. Res. Resour."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"590","DOI":"10.4244\/EIJ-D-22-00238","article-title":"Safety and performance of a novel cerebral embolic protection device for transcatheter aortic valve implantation: The PROTEMBO C Trial","volume":"18","author":"Jagielak","year":"2022","journal-title":"EuroIntervention"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.ijcard.2017.09.158","article-title":"Image-guidance for transcatheter aortic valve implantation (TAVI) and cerebral embolic protection","volume":"249","author":"Vernikouskaya","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"527","DOI":"10.2217\/fca-2020-0023","article-title":"WIRION\u2122 embolic protection system for carotid artery stenting and lower extremity endovascular intervention","volume":"16","author":"Giannopoulos","year":"2020","journal-title":"Futur. Cardiol."},{"key":"ref_41","first-page":"860","article-title":"First-in-Man Study Evaluating the Emblok Embolic Protection System During Transcatheter Aortic Valve Replacement","volume":"13","author":"Latib","year":"2020","journal-title":"JACC: Cardiovasc. Interv."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.jcin.2020.11.011","article-title":"Randomized Evaluation of TriGuard 3 Cerebral Embolic Protection After Transcatheter Aortic Valve Replacement: REFLECT II","volume":"14","author":"Nazif","year":"2021","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.jacc.2016.10.023","article-title":"Protection Against Cerebral Embolism During Transcatheter Aortic Valve Replacement","volume":"69","author":"Kapadia","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2088","DOI":"10.1016\/j.jacc.2019.08.1032","article-title":"Thrombotic Versus Bleeding Risk After Transcatheter Aortic Valve Replacement","volume":"74","author":"Mangieri","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e560","DOI":"10.1097\/MJT.0000000000001413","article-title":"Risk of Stroke After Transcatheter Aortic Valve Implantation: Epidemiology, Mechanism, and Management","volume":"28","author":"Ciobanu","year":"2021","journal-title":"Am. J. Ther."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"104","DOI":"10.3389\/fcvm.2018.00104","article-title":"Cerebrovascular Events After Transcatheter Aortic Valve Implantation","volume":"5","author":"Armijo","year":"2018","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_47","first-page":"1262","article-title":"Debris Heterogeneity across Different Valve Types Captured by a Cerebral Protection System during Transcatheter Aortic Valve Replacement","volume":"11","author":"Schmidt","year":"2018","journal-title":"JACC: Cardiovasc. Interv."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1056\/NEJMoa1514616","article-title":"Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients","volume":"374","author":"Leon","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1093\/ejcts\/ezs455","article-title":"Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"42","author":"Vahanian","year":"2012","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_50","first-page":"e35","article-title":"2020 ACC\/AHA Guideline for the Management of Patients with Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1056\/NEJMoa2204961","article-title":"Cerebral Embolic Protection during Transcatheter Aortic-Valve Replacement","volume":"387","author":"Kapadia","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.jacc.2016.12.002","article-title":"Cerebral Embolic Protection During TAVR: A Clinical Event Meta-Analysis","volume":"69","author":"Giustino","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2229","DOI":"10.1161\/CIRCULATIONAHA.120.052874","article-title":"Cerebral Embolic Protection and Outcomes of Transcatheter Aortic Valve Replacement: Results from the Transcatheter Valve Therapy Registry","volume":"143","author":"Butala","year":"2021","journal-title":"Circulation"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"A156","DOI":"10.1161\/hcq.12.suppl_1.156","article-title":"Abstract 156: Cost-Effectiveness Analysis of the Sentinel Cerebral Embolic Protection Device During Transcatheter Aortic Valve Replacement","volume":"12","author":"Ferket","year":"2019","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"B125","DOI":"10.1016\/j.jacc.2021.09.1158","article-title":"TCT-305 Cost-Effectiveness of Cerebral Embolic Protection with the SENTINEL Device in Transcatheter Aortic Valve Replacement: A US Medicare Payer Perspective","volume":"78","author":"Alkhouli","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2070","DOI":"10.1093\/eurheartj\/ehv191","article-title":"A prospective randomized evaluation of the TriGuard\u2122 HDH embolic DEFLECTion device during transcatheter aortic valve implantation: Results from the DEFLECT III trial","volume":"36","author":"Lansky","year":"2015","journal-title":"Eur. Hear. J."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1016\/j.athoracsur.2015.03.119","article-title":"Intraaortic Protection from Embolization in Patients Undergoing Transaortic Transcatheter Aortic Valve Implantation","volume":"100","author":"Wendt","year":"2015","journal-title":"Ann. Thorac. Surg."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"499","DOI":"10.4244\/EIJV12I4A84","article-title":"Filter-based cerebral embolic protection with transcatheter aortic valve implantation: The randomised MISTRAL-C trial","volume":"12","author":"Ahmad","year":"2016","journal-title":"EuroIntervention"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1111\/j.1540-8167.2009.01650.x","article-title":"Long-Term Functional and Neurocognitive Recovery in Patients Who Had an Acute Cerebrovascular Event Secondary to Catheter Ablation for Atrial Fibrillation","volume":"21","author":"Patel","year":"2010","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1161\/CIRCEP.109.859116","article-title":"Updated Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation","volume":"3","author":"Cappato","year":"2010","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1161\/CIRCEP.111.964916","article-title":"Ablation of atrial fibrillation under therapeutic warfarin reduces periprocedural complications: Evidence from a meta-analysis","volume":"5","author":"Santangeli","year":"2012","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1016\/j.hrthm.2011.05.017","article-title":"Incidence and predictors of major complications from contemporary catheter ablation to treat cardiac arrhythmias","volume":"8","author":"Bohnen","year":"2011","journal-title":"Heart Rhythm"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1161\/CIRCULATIONAHA.116.025546","article-title":"Brain Emboli After Left Ventricular Endocardial Ablation","volume":"135","author":"Whitman","year":"2017","journal-title":"Circulation"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0140-6736(09)61755-4","article-title":"Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): A multicentre randomised controlled trial","volume":"375","author":"Kuck","year":"2010","journal-title":"Lancet"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jacc.2014.04.029","article-title":"Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: The PREVAIL trial","volume":"64","author":"Holmes","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1988","DOI":"10.1001\/jama.2014.15192","article-title":"Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: A randomized clinical trial","volume":"312","author":"Reddy","year":"2014","journal-title":"JAMA"},{"key":"ref_67","first-page":"450","article-title":"Prevalence of auricular thrombosis before atrial flutter cardioversion: A 17-year transoesophageal echocardiographic study","volume":"18","author":"Cresti","year":"2015","journal-title":"EP Eur."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1111\/j.1540-8167.2008.01336.x","article-title":"Incidence and Predictors of Left Atrial Thrombus Prior to Catheter Ablation of Atrial Fibrillation","volume":"20","author":"Scherr","year":"2009","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.jjcc.2011.06.009","article-title":"Left atrial thrombus and prognosis after anticoagulation therapy in patients with atrial fibrillation","volume":"58","author":"Fukuda","year":"2011","journal-title":"J. Cardiol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1080\/17434440.2023.2208748","article-title":"Appropriate use criteria of left atrial appendage closure devices: Latest evidences","volume":"20","author":"Guarracini","year":"2023","journal-title":"Expert Rev. Med. Devices"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Preda, A., Baroni, M., Varrenti, M., Vargiu, S., Carbonaro, M., Giordano, F., Gigli, L., and Mazzone, P. (2023). Left Atrial Appendage Occlusion in Patients with Failure of Antithrombotic Therapy: Good Vibes from Early Studies. J. Clin. Med., 12.","DOI":"10.3390\/jcm12113859"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.hrthm.2023.01.007","article-title":"SCAI\/HRS expert consensus statement on transcatheter left atrial appendage closure","volume":"20","author":"Saw","year":"2023","journal-title":"Heart Rhythm"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.4244\/EIJY19M08_01","article-title":"EHRA\/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion\u2014An update","volume":"15","author":"Glikson","year":"2020","journal-title":"EuroIntervention"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1002\/ana.25700","article-title":"Ischemic Stroke despite Oral Anticoagulant Therapy in Patients with Atrial Fibrillation","volume":"87","author":"Seiffge","year":"2020","journal-title":"Ann. Neurol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1016\/j.echo.2014.08.016","article-title":"Prognostic Significance of Left Atrial Appendage \u201cSludge\u201d in Patients with Atrial Fibrillation: A New Transesophageal Echocardiographic Thromboembolic Risk Factor","volume":"27","author":"Lowe","year":"2014","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"50","DOI":"10.4244\/EIJ-D-21-00713","article-title":"Left atrial appendage closure for thrombus trapping: The international, multicentre TRAPEUR registry","volume":"18","author":"Sebag","year":"2022","journal-title":"EuroIntervention"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1002\/joa3.12838","article-title":"Left atrial appendage occlusion after thromboembolic events or left atrial appendage sludge during anticoagulation therapy: Is two better than one? Real-world experience from a tertiary care hospital","volume":"39","author":"Margonato","year":"2023","journal-title":"J. Arrhythmia"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1002\/ccd.29161","article-title":"Cerebral protection in left atrial appendage closure in the presence of appendage thrombosis","volume":"97","author":"Boccuzzi","year":"2021","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"3122","DOI":"10.1016\/j.jacc.2020.04.067","article-title":"Left Atrial Appendage Closure Versus Direct Oral Anticoagulants in High-Risk Patients with Atrial Fibrillation","volume":"75","author":"Osmancik","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"3762","DOI":"10.19102\/icrm.2019.100801","article-title":"Ventricular Tachycardia in Structural Heart Disease","volume":"10","author":"Lopez","year":"2019","journal-title":"J. Innov. Card. Rhythm Manag."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1842","DOI":"10.1016\/j.jacc.2017.01.047","article-title":"Management of Ventricular Arrhythmias in Patients with Advanced Heart Failure","volume":"69","author":"Santangeli","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Streitner, F., Herrmann, T., Kuschyk, J., Lang, S., Doesch, C., Papavassiliu, T., Streitner, I., Veltmann, C., Haghi, D., and Borggrefe, M. (2013). Impact of Shocks on Mortality in Patients with Ischemic or Dilated Cardiomyopathy and Defibrillators Implanted for Primary Prevention. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0063911"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"e2","DOI":"10.1016\/j.hrthm.2019.03.002","article-title":"2019 HRS\/EHRA\/APHRS\/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias","volume":"17","author":"Cronin","year":"2020","journal-title":"Heart Rhythm"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1093\/europace\/euac156","article-title":"Prevalence and risk factors of cardiac thrombus prior to ventricular tachycardia catheter ablation in structural heart disease","volume":"25","author":"Bonnin","year":"2023","journal-title":"Europace"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.jacc.2013.03.073","article-title":"Subtle Post-Procedural Cognitive Dysfunction After Atrial Fibrillation Ablation","volume":"62","author":"Medi","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Valeri, Y., Russo, A.D., Falanga, U., Volpato, G., Compagnucci, P., Barbarossa, A., Cipolletta, L., Parisi, Q., Casella, M., and Piva, T. (2022). First report of cerebral embolic protection system use during combined atrial fibrillation Pulse Field Ablation and left atrial appendage closure. Authorea, preprints.","DOI":"10.22541\/au.166033449.92347339\/v1"},{"key":"ref_87","first-page":"A16200","article-title":"Abstract 16200: Risk of Stroke After Catheter Ablation or Cardioversion for Atrial Fibrillation: Results from a Large Administrative Database, 2008\u20132012","volume":"130","author":"Noseworthy","year":"2014","journal-title":"Circulation"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"2550","DOI":"10.1161\/CIRCULATIONAHA.109.921320","article-title":"Periprocedural stroke and management of major bleeding complications in patients undergoing catheter ablation of atrial fibrillation: The impact of periprocedural therapeutic international normalized ratio","volume":"121","author":"Burkhardt","year":"2010","journal-title":"Circulation"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1111\/j.1540-8167.2009.01540.x","article-title":"Incidence and Predictors of Periprocedural Cerebrovascular Accident in Patients Undergoing Catheter Ablation of Atrial Fibrillation","volume":"20","author":"Scherr","year":"2009","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_90","first-page":"euad151","article-title":"Silent cerebral lesions following catheter ablation for atrial fibrillation: A state-of-the-art review","volume":"25","author":"Calvert","year":"2023","journal-title":"EP Eur."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1161\/CIRCEP.111.973453","article-title":"Microembolism and catheter ablation I: A comparison of irrigated radiofrequency and multielectrode-phased radiofrequency catheter ablation of pulmonary vein ostia","volume":"6","author":"Haines","year":"2013","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.ijcard.2014.03.175","article-title":"Cerebral microembolization during atrial fibrillation ablation: Comparison of different single-shot ablation techniques","volume":"174","author":"Kiss","year":"2014","journal-title":"Int. J. Cardiol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"e005612","DOI":"10.1161\/CIRCEP.117.005612","article-title":"Thromboembolic Risks of the Procedural Process in Second-Generation Cryoballoon Ablation Procedures","volume":"10","author":"Miyazaki","year":"2017","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"e003226","DOI":"10.1161\/CIRCEP.115.003226","article-title":"Effect of Left Atrial Ablation Process and Strategy on Microemboli Formation during Irrigated Radiofrequency Catheter Ablation in an In Vivo Model","volume":"9","author":"Takami","year":"2016","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.5114\/aoms.2020.94747","article-title":"Cerebral microembolism during atrial fibrillation ablation can result from the technical aspects and mostly does not cause permanent neurological deficit","volume":"16","author":"Puz","year":"2020","journal-title":"Arch. Med. Sci."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"e160","DOI":"10.4244\/EIJ-D-21-00646","article-title":"Cerebral embolisation during transcatheter edge-to-edge repair of the mitral valve with the MitraClip system: A prospective, observational study","volume":"18","author":"Braemswig","year":"2022","journal-title":"EuroIntervention"},{"key":"ref_97","unstructured":"Vella, C., Preda, A., Ferri, L., and Montorfano, M. (2023). Catheterization and Cardiovascular Interventions, Wiley."},{"key":"ref_98","first-page":"25","article-title":"Managing Stroke During Transcatheter Aortic Valve Replacement","volume":"12","author":"Hecker","year":"2017","journal-title":"Interv. Cardiol. Rev. Res. Resour."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s13741-020-00165-1","article-title":"A guide for pre-procedural imaging for transcatheter aortic valve replacement patients","volume":"9","author":"Perry","year":"2020","journal-title":"Perioper. Med."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.acvd.2016.02.012","article-title":"Extending percutaneous left atrial appendage closure indications using the AMPLATZER\u2122 Cardiac Plug device in patients with persistent left atrial appendage thrombus: The thrombus trapping technique","volume":"109","author":"Jalal","year":"2016","journal-title":"Arch. Cardiovasc. Dis."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"X48","DOI":"10.4244\/EIJV12SXA10","article-title":"Left atrial appendage closure: Patient, device and post-procedure drug selection","volume":"12","author":"Tzikas","year":"2016","journal-title":"EuroIntervention"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1111\/pace.12844","article-title":"Catheter Ablation of Ventricular Tachycardia in the Presence of an Old Endocavitary Thrombus Guided by Intracardiac Echocardiography","volume":"39","author":"Peichl","year":"2016","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1161\/CIRCEP.112.973461","article-title":"Microembolism and Catheter Ablation II","volume":"6","author":"Haines","year":"2013","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Zhang, J., Xia, S.-J., Du, X., Jiang, C., Lai, Y.-W., Wang, Y.-F., Jia, Z.-X., He, L., Tang, R.-B., and Dong, J.-Z. (2021). Incidence and risk factors of post-operative cognitive decline after ablation for atrial fibrillation. BMC Cardiovasc. Disord., 21.","DOI":"10.1186\/s12872-021-02139-7"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1111\/j.1540-8167.2009.01509.x","article-title":"Transcranial Measurement of Cerebral Microembolic Signals during Endocardial Pulmonary Vein Isolation: Comparison of Three Different Ablation Techniques","volume":"20","author":"Sauren","year":"2009","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1080\/030919099294393","article-title":"Blood damage, platelet and clotting activation during application of radiofrequency or cryoablation catheters: A comparative in vitro study","volume":"23","author":"Crijns","year":"1999","journal-title":"J. Med Eng. Technol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1093\/europace\/euq303","article-title":"MEDAFI-Trial (Micro-embolization during ablation of atrial fibrillation): Comparison of pulmonary vein isolation using cryoballoon technique vs. radiofrequency energy","volume":"13","author":"Neumann","year":"2011","journal-title":"Europace"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.jacc.2011.04.010","article-title":"Incidence of Asymptomatic Intracranial Embolic Events After Pulmonary Vein Isolation: Comparison of Different Atrial Fibrillation Ablation Technologies in a Multicenter Study","volume":"58","author":"Deneke","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1111\/j.1540-8167.2011.02050.x","article-title":"Incidence of Silent Cerebral Thromboembolic Lesions After Atrial Fibrillation Ablation May Change According to Technology Used: Comparison of Irrigated Radiofrequency, Multipolar Nonirrigated Catheter and Cryoballoon","volume":"22","author":"Gaita","year":"2011","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1093\/europace\/euv046","article-title":"Safety profile of multielectrode-phased radiofrequency pulmonary vein ablation catheter and irrigated radiofrequency catheter","volume":"18","author":"Wasmer","year":"2016","journal-title":"Europace"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1016\/j.hrthm.2013.04.005","article-title":"Does the number of simultaneously activated electrodes during phased RF multielectrode ablation of atrial fibrillation influence the incidence of silent cerebral microembolism?","volume":"10","author":"Wieczorek","year":"2013","journal-title":"Heart Rhythm"},{"key":"ref_112","first-page":"341","article-title":"Modified phased radiofrequency ablation of atrial fibrillation reduces the number of cerebral microembolic signals","volume":"16","author":"Zellerhoff","year":"2013","journal-title":"EP Eur."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1016\/j.jacep.2019.04.009","article-title":"Pulmonary Vein Isolation with Very High Power, Short Duration, Temperature-Controlled Lesions: The QDOT-FAST Trial","volume":"5","author":"Reddy","year":"2019","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1016\/j.jacep.2021.02.014","article-title":"Pulsed Field Ablation of Paroxysmal Atrial Fibrillation: 1-Year Outcomes of IMPULSE, PEFCAT, and PEFCAT II","volume":"7","author":"Reddy","year":"2021","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.1093\/europace\/euac050","article-title":"Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF)","volume":"24","author":"Ekanem","year":"2022","journal-title":"Europace"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/9\/1819\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:41:06Z","timestamp":1760128866000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/9\/1819"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,28]]},"references-count":115,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["life13091819"],"URL":"https:\/\/doi.org\/10.3390\/life13091819","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,28]]}}}