Late stroke after transcatheter aortic valve replacement: a nationwide study

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Neurology

Background:

• Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
• Long-term safety data, particularly regarding stroke risk, after TAVR is limited.
• Stroke is a significant concern that may influence post-TAVR management and guidelines.

Purpose of the Study:

• To determine the incidence of stroke at least 30 days after TAVR up to 8 years post-procedure.
• To compare the stroke risk in TAVR patients with the general population.
• To identify risk factors for late stroke and assess outcomes following stroke.

Main Methods:

• Nationwide, all-comers study using Swedish national registries (TAVR, stroke, diagnosis) from 2008-2018.
• Analysis of stroke incidence at least 30 days post-TAVR.
• Comparison of observed stroke rates with standardized incidence in an age- and sex-matched cohort.

Main Results:

• The annual stroke risk post-TAVR ranged from 2.0% to 3.1%, compared to 1.5% to 1.9% in the matched general population cohort.
• Identified risk factors for stroke included reduced renal function, diabetes, prior stroke, older age, and male sex.
• One-year mortality after stroke was 44%.

Conclusions:

• TAVR patients exhibit an increased incidence of stroke compared to the general population.
• The elevated stroke risk is partially attributable to a higher prevalence of pre-existing risk factors in the TAVR population.
• Further research into risk factor management and antithrombotic strategies post-TAVR is warranted.