**4. Summary of evidence**

The safety of embolic protection devices in TAVR has been extensively demonstrated in many trials and studies. However, CEPDs' efficacy and impact on hard clinical outcomes remains a controversial argument of debate. Some of the most recent meta-analyses showed indeed conflictual results. Woldendrop et al. on the European Heart Journal stated that using CEPDs did not result in a significant decrease in the occurrence of silent brain infarcts [50]. In two reviews and metaanalyses [66, 67] reporting results from randomized controlled trials (RCTs) and observational studies, the use of EPDs was effectively associated to fewer short-term stroke events. In contrast, other ones [68–70] (predominantly based on RCTs) did not show any difference on clinical outcomes or neuroimaging parameters. One of the most recent and updated summaries of evidence by Baloch et al. [71] comprehended 128,471 patients from RCTs and observational studies and highlighted the benefit of CEPD in reducing incidence of 30 day disabling stroke in patients undergoing TAVR; the majority of studies was based on TriGUARD and Sentinel devices.
