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Stroke After Transcatheter Aortic Valve Replacement: Incidence, Definitions, Etiologies and Management Options

Prakash A Patel1, Saumil Patel1, Jared W Feinman1

  • 1Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

Journal of Cardiothoracic and Vascular Anesthesia
|November 28, 2017
PubMed

Insights

Neurologic complications following transcatheter aortic valve replacement (TAVR) require integrated perioperative management. Ongoing research into embolic protection and valve thrombosis aims to further reduce stroke risks in TAVR patients.

Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Interventional Cardiology

Background:

  • Neurologic complications, particularly stroke, are significant adverse events after transcatheter aortic valve replacement (TAVR).
  • Understanding the etiologies of stroke is crucial for developing effective prevention and management strategies.
  • The perioperative pathway presents multiple opportunities for intervention to mitigate neurologic risks.

Purpose of the Study:

  • To emphasize the importance of an integrated, triphasic approach to managing neurologic complications during the TAVR perioperative pathway.
  • To highlight the ongoing refinement of strategies aimed at reducing stroke risk, including embolic protection and addressing valve thrombosis.
  • To discuss the impact of this neurologic focus on cardiovascular clinical trials and the development of new diagnostic guidelines.

Main Methods:

  • Review and synthesis of current knowledge on neurologic complications post-TAVR.
  • Analysis of the perioperative pathway in three distinct phases: pre-procedural, intra-procedural, and post-procedural.
  • Examination of emerging technologies and strategies, such as embolic protection devices and valve thrombosis management.
  • Evaluation of the influence on cardiovascular clinical trial design and guideline development.

Main Results:

  • A comprehensive, integrated approach across all perioperative phases is essential for addressing TAVR-related stroke.
  • Continued refinement of techniques and technologies, including embolic protection and valve thrombosis management, is critical for further risk reduction.
  • The heightened focus on neurologic events has spurred advancements in diagnostic and assessment guidelines for cardiovascular interventions.

Conclusions:

  • Integrated perioperative management is key to minimizing devastating neurologic complications after TAVR.
  • Future research and technological advancements will further enhance the safety of TAVR by reducing stroke incidence.
  • Novel guidelines are transforming the approach to diagnosing and assessing neurologic injury in patients undergoing cardiovascular interventions.

Keywords:
American College of CardiologyAmerican Heart AssociationAmerican Stroke AssociationEmbrella deviceMontage deviceNeurologic Academic Research ConsortiumSentinel deviceSociety of Thoracic SurgeonsTriguard deviceValve Academic Research Consortiumaortic archballoon-inflatable valvebivalirudincerebral embolismcognitive functiondefinitionsdiffusion weighted magnetic resonance imagingembolic protectionhemorrhageheparininfarctionmodified Rankin scalemortalitynovel oral anticoagulantsplatelet blockadeself-expanding valvestrokethrombosistranscatheter aortic valve replacementtranscranial Dopplertransient ischemic attacktrial endpoints

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