Understanding neurologic complications following TAVI

Abstract

Transcatheter aortic valve replacement is a groundbreaking treatment modality for severe, symptomatic aortic stenosis. Despite the rapid progression in indications to include intermediate-risk patients, the risk of peri-procedural stroke remains, with a higher incidence rate than previously reported. Accurate assessment of peri-procedural stroke rates requires selection of careful and meaningful trial endpoints during evaluation of neuroprotective devices. In this article, we review recommendations and stroke definitions from academic research consortiums along with device trial results.

Utility of cerebral oximetry in balloon mitral valvotomy and its correlation with post-procedure neurological complications: A pragmatic prospective observational study

“…Use of DW-MRI as an additional diagnostic tool in patients with lower rSO 2 values can increase earlier detection of NCs and better management of patients. [ 29 ]…”

Evaluation of Cerebral Thromboembolism After Transcatheter Aortic Valve Replacement (EARTH TAVR): A Serial Magnetic Resonance Imaging Evaluation as Substudy of the GALILEO Trial

“…5 Previous post-TAVR cerebral MRI studies reported a higher ischemic brain lesion volume of 1.5 to 4.3cm 3 in up to 77% of patients, if compared with our results in a low surgical risk population. 1 Potential limitations of this study may be the small sample size, a change in the medical regimen in patients with new-onset AF, and a heterogeneity of procedures (several valve-in-valve procedures, use of protection devices in some patients).…”

“…1 The mechanism of cerebral embolism may differ according to the early time period (procedure related within 48 hours of TAVR), or later (nondirectly procedure related, eg, atrial fibrillation [AF] or valve leaflet thrombosis). 1 In the PARTNER trial (The Placement of Aortic Transcatheter Valves), 62.5% of the major strokes occurred within the first 48 hours post-TAVR, 25% between days 5 and 30, and 1 stroke was noted after the first month. 2 Mobilization of debris from the calcified native aortic valve or the aorta during the implant procedure may explain a significant proportion of early strokes.…”

“…Ischemic stroke is an important complication in 2% to 6% of patients within 90 days following transcatheter aortic valve replacement (TAVR). 1 The mechanism of cerebral embolism may differ according to the early time period (procedure related within 48 hours of TAVR), or later (nondirectly procedure related, eg, atrial fibrillation [AF] or valve leaflet thrombosis). 1 In the PARTNER trial (The Placement of Aortic Transcatheter Valves), 62.5% of the major strokes occurred within the first 48 hours post-TAVR, 25% between days 5 and 30, and 1 stroke was noted after the first month.…”

“…5 Previous post-TAVR cerebral MRI studies reported a higher ischemic brain lesion volume of 1.5 to 4.3cm 3 in up to 77% of patients, if compared with our results in a low surgical risk population. 1…”