Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Replacement: A Review

Area of Science:

• Cardiology
• Neurology
• Medical Imaging

Background:

• Cerebrovascular events (CVEs) are a serious complication following transcatheter aortic valve replacement (TAVR).
• Despite improvements, CVEs remain a concern, especially with increasing TAVR utilization.
• CVEs can occur during or after TAVR, linked to valve thrombosis, atrial fibrillation, and other factors.

Purpose of the Study:

• To review the incidence, mechanisms, and potential preventive strategies for CVEs in TAVR patients.
• To evaluate the role of cerebral embolic protection devices and anticoagulation therapies.
• To highlight the importance of risk stratification for personalized CVE prevention.

Main Methods:

• Review of existing literature on TAVR-associated CVEs.
• Analysis of data from clinical trials investigating embolic protection devices.
• Examination of imaging findings (e.g., CT scans) for subclinical infarcts and valve thrombosis.

Main Results:

• High prevalence of subclinical cerebral infarcts (68%-98%) post-TAVR.
• Clinically evident CVE rates range from 1-5% depending on patient risk.
• Embolic protection devices show potential in reducing lesion volume but not overall stroke rate.
• Valve thrombosis occurs in 10-15% of patients and is linked to increased CVE risk.
• Anticoagulation increases bleeding risk without significantly reducing thromboembolism compared to antiplatelet therapy.

Conclusions:

• CVEs are a significant complication of TAVR, with both procedural and late-onset causes.
• Current embolic protection devices lack robust evidence for reducing overall stroke rates.
• Risk stratification is crucial for tailoring preventive therapies to high-risk TAVR patients.