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Updated: Aug 28, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Management and Outcome of Acute Ischemic Stroke Complicating Transcatheter Aortic Valve Replacement
Amos Levi1, Matthias Linder2, Moritz Seiffert2
1Rabin Medical Center, Petah-Tikva, Israel; Tel Aviv University, Tel Aviv Israel.
Insights
Acute ischemic stroke complicating transcatheter aortic valve replacement (TAVR) is a serious concern. Timely neurointervention may improve neurologic disability in patients with moderate to severe strokes after TAVR.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Interventional Cardiology
Background:
- Transcatheter aortic valve replacement (TAVR) is advancing, yet periprocedural acute ischemic stroke remains a significant complication.
- Understanding the incidence and outcomes of stroke following TAVR is crucial for patient management.
Purpose of the Study:
- To investigate acute ischemic stroke complicating TAVR (AISCT).
- To describe the indications and outcomes of neurointerventions (NI) for AISCT.
Main Methods:
- An international multicenter registry collected data on AISCT within 30 days of TAVR.
- Stroke severity was assessed using the NIH Stroke Scale; outcomes included 1-year mortality and 90-day neurologic disability (modified Rankin Scale).
Main Results:
- AISCT occurred in 2.3% of 16,615 TAVR procedures.
- 1-year mortality rates were 28.9% (mild), 35.9% (moderate), and 77.5% (severe) stroke.
- Neurointervention (NI) was performed in 10.1% of patients; NI was associated with improved odds of independent survival at 90 days in a multivariable model.
Conclusions:
- AISCT is associated with substantial morbidity and mortality, directly correlated with stroke severity.
- Timely neurointervention may improve neurologic outcomes for patients with moderate or severe AISCT.
- Enhanced collaboration between cardiology and neurology is vital for optimizing AISCT management.
Background:
Despite advances in transcatheter aortic valve replacement (TAVR), periprocedural acute ischemic stroke remains a concern.
Objectives:
The aims of this study were to investigate acute ischemic stroke complicating TAVR (AISCT) and to describe the indications and outcomes of interventions to treat AISCT.
Methods:
An international multicenter registry was established focusing on AISCT within 30 days of TAVR. Stroke severity was assessed using the National Institutes of Health Stroke Scale. Primary outcomes were 1-year all-cause death and neurologic disability status at 90 days according to modified Rankin scale score.
Results:
Of 16,615 TAVR procedures, 387 patients with AISCT were included (2.3%). Rates of 1-year death were 28.9%, 35.9%, and 77.5% in patients with mild, moderate, and severe stroke, respectively (P < 0.001). Although 348 patients were managed conservatively, 39 patients (10.1%) underwent neurointervention (NI) with either mechanical thrombectomy (n = 26) or thrombolytic therapy (n = 13). In a subanalysis excluding patients with mild stroke, there was no clear 1-year survival benefit for NI compared with conservative management (47.6% vs 41.1%, respectively; P = 0.78). In a logistic regression model controlling for stroke severity, NI was associated with 2.9-fold odds (95% CI: 1.2-7.0; P = 0.016) of independent survival at 90 days.
Conclusions:
AISCT carries significant morbidity and mortality, which is correlated with stroke severity. The present findings suggest that neurologic disability for patients with moderate or worse stroke could potentially be improved by timely intervention and highlight the importance of collaboration between cardiologists and neurologists to optimize AISCT outcomes.
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