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Updated: Sep 5, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Cerebrovascular Events after Transcatheter Aortic Valve Replacement: The Difficulty in Predicting the Unpredictable
Oliver Maier1, Georg Bosbach1, Kerstin Piayda2
1Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Duesseldorf, Germany.
Insights
A new risk model using multimodal imaging accurately predicts cerebrovascular events (CVE) after transcatheter aortic valve replacement (TAVR). This model, incorporating pre-procedural factors, outperforms existing scores for improved patient outcomes.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Cerebrovascular events (CVE) are significant complications after transcatheter aortic valve replacement (TAVR).
- Accurate prediction of CVE risk is crucial for patient management and procedural planning.
- Current risk stratification models may not fully capture CVE risk in TAVR patients.
Purpose of the Study:
- To develop and validate a novel risk prediction model for CVE following TAVR.
- To investigate the utility of multimodal imaging in enhancing CVE risk assessment.
- To compare the performance of the new model against existing risk scores.
Main Methods:
- Development of a risk model using pre-procedural data from 1365 TAVR patients (derivation cohort).
- Inclusion of multimodal imaging parameters: aortic valve area, aortic angulation, and calcification in specific aortic regions.
- Validation of the model in an independent cohort of 650 TAVR patients.
Main Results:
- A total of 72 (3.6%) patients experienced TAVR-related CVE.
- Key predictors identified: prior CVE history, larger aortic valve area, increased aortic angulation, and enhanced calcification in the right coronary cusp, LVOT, and ascending aorta.
- The new risk model demonstrated superior in-hospital CVE prediction (AUC 0.73) compared to EuroSCORE II and CHA2DS2-VASc scores.
Conclusions:
- Multimodal imaging offers a promising avenue for developing more accurate CVE risk models in TAVR patients.
- The developed risk model shows improved predictive performance for in-hospital CVE post-TAVR.
- This approach can aid in better patient selection and risk stratification for TAVR procedures.
Abstract:
Background: Cerebrovascular events (CVE) are feared complications following transcatheter aortic valve replacement (TAVR). We aimed to develop a new risk model for CVE prediction with the application of multimodal imaging. Methods: From May 2011 to August 2019, a total of 2015 patients underwent TAVR at our institution. The study cohort was subdivided into a derivation cohort (n = 1365) and a validation cohort (n = 650) for risk model development. Results: Of 2015 patients, 72 (3.6%) developed TAVR-related CVE. Pre-procedural factors of our risk model were history of prior CVE, a larger aortic valve area (≥0.55 cm2), a large aortic angulation (≥48.5°), and enhanced calcification of the right coronary cusp (≥447.2 AU), left ventricular outflow tract (≥262.4 AU), and ascending thoracic aorta (≥116.4 AU). Our risk model was superior for in-hospital CVE prediction following TAVR in the establishment cohort (AUC 0.73, 95% CI 0.66−0.80; p < 0.001) compared to other risk scores, such as the EuroSCORE II or the CHA2DS2-VASc score. Conclusions: Although CVE prediction in patients undergoing TAVR is challenging due to the complex nature of the TAVR procedure, our study highlights that multimodal imaging is a promising approach to generate a more accurate risk model for CVE prediction.
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