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@article{Khawaja:2026:10.4244/EIJ-D-26-00425,
author = {Khawaja, SA and Hanna, L and Singh, A and Lucarelli, C and Garg, P and Malik, I and Hadjiloizou, N and Ruparelia, N and Hartley, A and Khamis, R and Shin, MS and Gibbs, R and Mikhail, GW},
doi = {10.4244/EIJ-D-26-00425},
journal = {EuroIntervention},
pages = {883--890},
title = {A randomised trial of carbon dioxide flushing to reduce vascular brain injury in patients undergoing TAVI.},
url = {http://dx.doi.org/10.4244/EIJ-D-26-00425},
volume = {22},
year = {2026}
}
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TY  - JOUR
AB  - BACKGROUND: Stroke remains a significant concern in patients undergoing transcatheter aortic valve implantation (TAVI). Despite advances in TAVI technology and techniques, stroke rates have remained unchanged, with trials of cerebral embolic protection devices failing to reduce rates. The concept of air emboli has not been previously investigated in TAVI procedures. We hypothesised that gaseous emboli could play a significant role in TAVI and that carbon dioxide (CO2) flushing of the TAVI valves could reduce the incidence of new neurological lesions post-TAVI. AIMS: We aimed to demonstrate the neuroprotective benefits of CO2 flushing in TAVI patients. METHODS: INTERCEPTavi is a single-centre, blinded, randomised controlled pilot trial that studied the effects of flushing TAVI valves with CO2 versus conventional saline on neurological outcomes post-TAVI, assessed using magnetic resonance imaging (MRI) and transcranial Doppler (TCD). Patients with aortic stenosis were randomised after obtaining vascular access. Periprocedural TCD assessed solid and gaseous emboli to the brain. Post-procedure, patients underwent brain MRI to detect lesions. Here, we report the primary outcome of feasibility, as well as the secondary MRI and mechanistic TCD outcomes. RESULTS: A total of 60 patients were recruited and randomised 1:1 to CO2 and saline flushing (TAVI-CO2) versus saline flushing only (TAVI-S). CO2 flushing significantly reduced the average number of lesions per patient (TAVI-CO2: 4 lesions/patient vs TAVI-S: 8.5 lesions/patient; p=0.031). The total infarct area was numerically lower in the TAVI-CO2 group (40.32 mm2 vs 93.20 mm2), although this did not reach statistical significance (p=0.111). Similarly, TCD showed fewer microembolic signals in the TAVI-CO2 arm, primarily due to a reduction in gaseous emboli, but this difference was not statistically significant (p=0.5). CONCLUSIONS: INTERCEPTavi is a pioneering, first-in-human randomised trial that demonstrated that CO2 flu
AU  - Khawaja,SA
AU  - Hanna,L
AU  - Singh,A
AU  - Lucarelli,C
AU  - Garg,P
AU  - Malik,I
AU  - Hadjiloizou,N
AU  - Ruparelia,N
AU  - Hartley,A
AU  - Khamis,R
AU  - Shin,MS
AU  - Gibbs,R
AU  - Mikhail,GW
DO  - 10.4244/EIJ-D-26-00425
EP  - 890
PY  - 2026///
SP  - 883
TI  - A randomised trial of carbon dioxide flushing to reduce vascular brain injury in patients undergoing TAVI.
T2  - EuroIntervention
UR  - http://dx.doi.org/10.4244/EIJ-D-26-00425
UR  - https://www.ncbi.nlm.nih.gov/pubmed/42200667
VL  - 22
ER  -
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