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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Periprocedural Strategies for Stroke Prevention in Patients Undergoing Transcatheter Aortic Valve Implantation

Matthias Linder1, Moritz Seiffert1,2

  • 1Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Frontiers in Cardiovascular Medicine
|May 13, 2022
PubMed

Insights

Preventing strokes during transcatheter aortic valve implantation (TAVI) is crucial, especially for younger patients. Current embolic protection devices show no clear benefit, highlighting the need for comprehensive procedural and periprocedural stroke prevention strategies.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Devices

Background:

  • Cerebrovascular events are a significant complication following transcatheter aortic valve implantation (TAVI), occurring in 2-3% of patients within 30 days.
  • The expansion of TAVI to lower-risk and younger patient populations increases the importance of stroke prevention strategies.
  • Existing cerebral embolic protection devices have not demonstrated clear clinical benefits in randomized trials.

Purpose of the Study:

  • To summarize current approaches for stroke prevention in TAVI patients.
  • To discuss the multifactorial etiology of periprocedural strokes.
  • To identify and discuss open questions regarding stroke prevention in TAVI.

Main Methods:

  • Review of existing literature on TAVI-associated cerebrovascular events.
  • Analysis of data from randomized trials evaluating cerebral embolic protection devices.
  • Discussion of procedural and periprocedural stroke prevention strategies.

Main Results:

  • Cerebral embolic protection devices have not yet shown a clear clinical benefit in randomized trials.
  • Stroke prevention in TAVI requires a multifactorial approach addressing various predisposing factors.
  • The need for comprehensive strategies beyond device-based interventions is indicated.

Conclusions:

  • Stroke prevention in TAVI necessitates a holistic strategy encompassing procedural and periprocedural measures.
  • Further research is needed to optimize stroke prevention in the evolving landscape of TAVI.
  • Addressing the multifactorial nature of stroke risk is key to improving patient outcomes after TAVI.

Keywords:
TAVIanticoagulationantithrombotic therapycerebrovascular embolic protectionstroke

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