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Stroke events after transcatheter aortic valve implantation: Temporal relationships and affected brain regions

American Heart Journal Feb 11, 2022

According to findings, the majority of strokes were experienced early after transcatheter aortic valve implantation (TAVI) – but not necessarily during the procedure – and impacted multiple brain regions only partially protected by current cerebral embolic protection (CEP) devices. Efficient prophylaxis of cerebrovascular events could require strategies beyond the TAVI procedure to decrease stroke risk.

  • Periprocedural strokes continue to be a devastating complication in TAVI, and randomized controlled trials failed to show a decrease in clinically apparent strokes or death post-TAVI due to CEP.

  • Screening for cerebrovascular events was performed among 3,164 consecutive patients treated with TAVI, and affected cerebral regions were ascertained by clinical symptoms and brain imaging.

  • At 30 days, disabling stroke and non-disabling stroke rates were estimated to be 2.2% and 1.4%, respectively.

  • Reduction in the frequency of all strokes was noted, from 5.0% to 3.0% over time.

  • A higher stroke risk was present in patients with impaired left-ventricular function (OR 2.19), increased CHA2DS2-VASc (OR 1.39) and moderate/severe spontaneous echo contrast (OR 3.60).

  • Acute symptom onset happened during TAVI (19.4%), within 24 hours (40.3%) or later (25.0%); 98.3% of strokes were of ischemic origin.

  • Overall, 53.2% of lesions in intraprocedural strokes were located at regions considered protected by current CEP devices and 37.5% of patients with intraprocedural strokes were exclusively affected in these areas.

  • There was no link between baseline or procedural parameters and embolic distribution patterns.

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