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

Amos Levi*, Matthias Linder, ASTRO-TAVI Study Group, Moritz Seiffert, Guy Witberg, Thomas Pilgrim, Daijiro Tomii, Yeela Talmor-Barkan, Nicolas M. Van Mieghem, Rik Adrichem, Pablo Codner, David Hildick Smith, Sandeep Arunothayaraj, Leor Perl, Ariel Finkelstein, Itamar Loewenstein, Michael Findler, Lars Søndergaard, Ole De Backer, Christina WangRani Barnea, Giuseppe Tarantini, Luca Nai Fovino, Hana Vaknin-Assa, Darren Mylotte, Mattia Lunardi, Guy Raphaeli, John G. Webb, Mariama Akodad, Antonio Colombo, Antonio Mangieri, Azeem Latib, Faraj Kargoli, Francesco Giannini, Alfonso Ielasi, James Cockburn, Focko L. Higgen, Itay Aviram, Mauro Gitto, Thijmen W. Hokken, Eitan Auriel, Ran Kornowski

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1808-1819
Number of pages12
JournalJACC: Cardiovascular Interventions
Volume15
Issue number18
DOIs
Publication statusPublished - 26 Sept 2022

Bibliographical note

Funding Support and Author Disclosures:
Dr Pilgrim has received research grants to the institution from Edwards Lifesciences, Boston Scientific, and Biotronik; has received personal fees from Biotronik and Boston Scientific; has received other compensation from HighLife SAS and Medira; and is a proctor for Medtronic. Dr De Backer has received research grants and consulting fees from Abbott and Boston Scientific. Dr Søndergaard has received consulting fees and institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr Van Mieghem has received research grant support from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, PulseCath BV, and Daiichi Sankyo; and has received advisory fees from Abbott, Boston Scientific, Ancora, Medtronic, PulseCath BV, and Daiichi Sankyo. Dr Webb has been a consultant to and has received research funding from Edwards Lifesciences, Medtronic, and Boston Scientific. Dr Cockburn is a proctor for Boston Scientific. Dr Seiffert has served as a consultant for JenaValve and Boston Scientific; has received travel compensation from Edwards Lifesciences, JenaValve, Boston Scientific, and Biotronik; and has received speaker honoraria from Medtronic. Dr Mangieri has received a research grant (to the institution) from Boston Scientific; and has served on a medical advisory board for Boston Scientific. Dr Latib has served on advisory boards for Medtronic and Abbott; and has been a consultant to Edwards Lifesciences. Dr Akodad has received research funding from Medtronic, Biotronik, MUSE Explore, and Federation Française de Cardiologie. Dr Perl is a consultant for Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright: © 2022

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