Transcatheter aortic valve replacement and stroke: a comprehensive review

Area of Science:

• Cardiology
• Neurology
• Interventional Cardiology

Background:

• Transcatheter aortic valve implantation (TAVR) is a key treatment for severe aortic stenosis in high-risk patients.
• Stroke is a significant complication, primarily occurring early post-TAVR due to embolization, with later events linked to patient factors.

Purpose of the Study:

• To review the evolving landscape of stroke risk following TAVR.
• To highlight the importance of stroke prophylaxis as TAVR indications expand to lower-risk populations.

Main Methods:

• Review of clinical evidence and pathophysiological mechanisms of stroke post-TAVR.
• Discussion of current research directions including technological improvements, antithrombotic therapy, and embolic protection devices.

Main Results:

• Clinical stroke rates post-TAVR have decreased, but MRI reveals near-universal new ischemic lesions.
• These subclinical lesions may correlate with reduced neurocognitive function.

Conclusions:

• Stroke prevention during and after TAVR is critical, especially with expanding patient eligibility.
• Multi-faceted strategies including device innovation, optimized antithrombotic regimens, and careful patient selection are essential.