**1. Introduction**

Aortic stenosis is the most prevalent valve disease in the developed countries. Its prevalence increases in the elderly; in this population, transcatheter aortic valve replacement (TAVR) is a viable option for subjects with intermediate or high risk of cardiac surgery. Despite the development of new generations of TAVR, cerebrovascular events are one of the most severe and scary complications because of the increase

in morbidity and mortality, the risk of stroke at 30 days ranges from 2.7 to 10% [1, 2]. Apart from clinical strokes, subclinical strokes, defined by the appearance of new ischemic cerebral lesions by MRI, appear in 90% of patients undergoing TAVR [3]; however, their clinical significance is still unknown.

TAVR implantation-related strokes are divided into acute or periprocedural and late. For prevention, various methods have been identified. In the first group (acute), the main factors to take into consideration include optimization of the TAVR technique with reduction of embolization of calcified fragments and atheroma, and adequate anticoagulation during the procedure. For late strokes, the main factor is the use of an optimal antithrombotic regimen after implantation.

The greatest risk of embolization to the brain occurs during the procedure, during the positioning or implantation phase of the valve, as a result of manipulation of highly calcified structures or atheromatous embolization of thrombi or material [4]. Up to 70% of patients experience a stroke in the first 24 hours [5–7] with a considerable deterioration in quality of life and a 3–5-fold increase in mortality [8]. Cerebral protection devices (CPDs) have the potential to reduce stroke and ischemic brain injury associated with percutaneous aortic valve replacement. The results of a recent study that analyzed a database with 36,220 patients (525 of them with CPD systems and 35,695 without them) found that the use of a CPD was associated with a lower incidence of ischemic stroke (1.0% vs. 3.8%, p < 0.002) and lower in-hospital mortality. Importantly, silent strokes account for a significant proportion of these complications and are associated with a threefold increased risk of having a stroke, a further decline in cognitive function, and a twofold increased risk of developing dementia after follow-up for 4 years [9].

Until March 2023, only two authorized devices were identified as DPC, the Sentinel device, which is designed to capture emboli or debris detached during TAVI. It consists of a dual filter into the left common carotid and brachycephalic artery; inside a 6Fr catheter that is accessed through the radial artery, the proximal filter is placed in the brachiocephalic artery and the distal filter in the common carotid artery (available in United States and Europe) [1] and the TriGUARD 3 (available in Europe) is the only device that covers all the arteries of the aortic arch. Being a deflector device, it rejects emboli during TAVR placement. This device is advanced *via* femoral contralateral access to TAVI placement and is deployed to protect the supra-aortic vessels [10].
