Management and Outcome of Acute Ischemic Stroke Complicating Transcatheter Aortic Valve Replacement.

Levi, Amos; Linder, Matthias; Seiffert, Moritz; Witberg, Guy; Pilgrim, Thomas; Tomii, Daijiro; Talmor-Barkan, Yeela; Van Mieghem, Nicolas M; Adrichem, Rik; Codner, Pablo; Smith, David Hildick; Arunothayaraj, Sandeep; Perl, Leor; Finkelstein, Ariel; Loewenstein, Itamar; Findler, Michael; Søndergaard, Lars; De Backer, Ole; Wang, Christina; Barnea, Rani; ... (2022). Management and Outcome of Acute Ischemic Stroke Complicating Transcatheter Aortic Valve Replacement. JACC. Cardiovascular Interventions, 15(18), pp. 1808-1819. Elsevier 10.1016/j.jcin.2022.06.033

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BACKGROUND

Despite advances in transcatheter aortic valve replacement (TAVR), periprocedural acute ischemic stroke remains a concern.

OBJECTIVES

The aims of this study were to investigate acute ischemic stroke complicating TAVR (AISCT) and to describe the indications and outcomes of interventions to treat AISCT.

METHODS

An international multicenter registry was established focusing on AISCT within 30 days of TAVR. Stroke severity was assessed using the National Institutes of Health Stroke Scale. Primary outcomes were 1-year all-cause death and neurologic disability status at 90 days according to modified Rankin scale score.

RESULTS

Of 16,615 TAVR procedures, 387 patients with AISCT were included (2.3%). Rates of 1-year death were 28.9%, 35.9%, and 77.5% in patients with mild, moderate, and severe stroke, respectively (P < 0.001). Although 348 patients were managed conservatively, 39 patients (10.1%) underwent neurointervention (NI) with either mechanical thrombectomy (n = 26) or thrombolytic therapy (n = 13). In a subanalysis excluding patients with mild stroke, there was no clear 1-year survival benefit for NI compared with conservative management (47.6% vs 41.1%, respectively; P = 0.78). In a logistic regression model controlling for stroke severity, NI was associated with 2.9-fold odds (95% CI: 1.2-7.0; P = 0.016) of independent survival at 90 days.

CONCLUSIONS

AISCT carries significant morbidity and mortality, which is correlated with stroke severity. The present findings suggest that neurologic disability for patients with moderate or worse stroke could potentially be improved by timely intervention and highlight the importance of collaboration between cardiologists and neurologists to optimize AISCT outcomes.

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