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Updated: Nov 6, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Late stroke after transcatheter aortic valve replacement: a nationwide study
Henrik Bjursten1, Bo Norrving2, Sigurdur Ragnarsson3
1Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, 221 85, Lund, Sweden. henrik.bjursten@med.lu.se.
Insights
Long-term stroke risk after transcatheter aortic valve replacement (TAVR) is higher than in the general population. However, this increased risk is partly explained by patient factors, not solely the TAVR procedure itself.
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.
Abstract:
Transcatheter aortic valve replacement (TAVR) is a rapidly growing field. Short-term safety and efficacy of these procedures have been studied extensively. However, little is known about the safety of these devices over time. Stroke is one feared long-term complication, and an increased stroke rate could affect guidelines for treating both the aortic stenosis and choosing antithrombotic therapy after TAVR. The primary objective was to study the incidence of stroke up to 8 years after TAVR implantation, comparing it with the risk of stroke in the general population. Secondary objectives were to study risk factors for late stroke and to study outcomes after stroke. A nationwide, all-comers study of patients who underwent TAVR in Sweden 2008-2018 was performed. The study was based on data from three national registries: a TAVR registry, a stroke registry, and a diagnosis registry. The main outcome was stroke incidence 30-days or more after TAVR implantation and was compared to a standardized incidence. The annual risk for stroke varied between 2.0% and 3.1% as compared to 1.5% and 1.9% in an age- and sex-matched cohort. Risk factors for developing stroke were reduced renal function, diabetes, history of stroke, age, and male sex. The 1-year mortality after stroke was 44%. This study demonstrated an increased rate of stroke after TAVR, but the findings suggest that this can in part be attributed to the group's higher frequency of pre-disposing risk factors.
