Stroke prevention during and after transcatheter aortic valve implantation: From cerebral protection devices to antithrombotic management

Abstract

Since its conception, transcatheter aortic valve implantation (TAVI) has undergone important improvements both in the implantation technique and in transcatheter devices, allowing an enthusiastic adoption of this therapeutic approach in a wide population of patients previously without a surgical option and managed conservatively. Nowadays, patients with severe symptomatic aortic stenosis are typically managed with TAVI, regardless of their risk to surgery, improving the prognosis of patients and thus achieving an exponential global expansion of its use. However, thromboembolic and hemorrhagic complications remain a latent concern in TAVI recipients. Both complications can appear simultaneously in the periprocedural period or during the follow-up, and when minor, they resolved without apparent sequelae, but in a relevant percentage of cases, they are devastating, overshadowing the benefit achieved with TAVI. Our review outlines the etiology and incidence of thromboembolic complications associated with TAVI, the main current strategies for their prevention, and the implications of its pharmacological management at the follow-up in a TAVI population, mostly frail and predisposed to bleeding complications.

Nondual Antiplatelet Therapy Versus Dual Antiplatelet Therapy Before Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-analysis

“…Patients with combined diseases also have an increased risk of ischemic stroke. 28 Stroke has a significant impact on mortality in patients after TAVR; therefore, patients need to receive antiplatelet therapy to reduce thrombosis and improve prognosis. However, patients still have perioperative ischemia and bleeding complications, especially frail and elderly patients who have high surgical risk, more comorbidities, and a higher risk of complications.…”

Transcatheter Aortic Valve Replacement in Elderly Patients: Opportunities and Challenges

“…One of the harshest and most harmful adverse effects of TAVR is stroke, which has a direct correlation with severe disability and high death. The incidence of stroke or transient ischemic attack in individuals 30 days and 1 year after TAVR was found to be 0.6-6.7% and 2.2-10.4% in pivotal randomized TAVR trials [48][49][50]. Most early strokes occurred in the first 3 days after TAVR.…”