There was, however, one unexpected and counterintuitive finding: The greatest stroke reduction with cerebroembolic protection was seen in patients with the least aortic valve calcium. This prompted session cochair, professor of medicine at the University of Rouen, France, to observe that perhaps valve repositioning is an important factor in TAVR-related strokes. After all, he noted, valve repositioning occurs more often when a patient’s valves are softer and less calcified.
“This is a very important point,” Dr. Jilaihawi responded. “I think there is an interplay between procedural aspects and the anatomy which is not completely captured in this study because we don’t know whose valve was repositioned multiple times.”
He added that the finding that TAVR-related stroke is more common in patients with less calcified aortic valves is consistent with the earlier experience in carotid stenting.
“If you look 10 years ago in the field of carotid stenting, there were a lot of analyses done which concluded that the highest-risk lesions are the least calcified lesions, even though it’s counterintuitive,” he said.
Discussant, director of interventional cardiac research at Cedars-Sinai Medical Center in Los Angeles, said the take-home point from the SENTINEL analysis is clear: “Cerebroembolic protection is like a seat belt: You should wear it. All patients should wear it.”
The SENTINEL trial was sponsored by Claret Medical. Dr. Jilaihawi reported receiving research grants from Abbott and Medtronic and serving as a consultant to Edwards Lifesciences and Venus Medtech.
SOURCE: Jilaihawi H. EuroPCR 2018.