Cerebrovascular Accident Risk and Guidewire Choice in Transcatheter Aortic Valve Replacement Procedure

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Device Technology

Background:

• Transcatheter aortic valve replacement (TAVR) is a key treatment for severe symptomatic aortic stenosis (AS), especially in high-risk patients.
• Guidewire manipulation across the aortic valve (AV) during TAVR carries potential risks, including cerebrovascular accidents (CVA).
• Understanding guidewire impact on procedural safety is crucial for optimizing TAVR outcomes.

Purpose of the Study:

• To compare the incidence of CVA and other periprocedural outcomes based on guidewire type used for AV crossing in TAVR.
• To evaluate the safety and efficacy of different guidewires in the context of TAVR procedures.

Main Methods:

• Retrospective analysis of 537 patients undergoing TAVR for symptomatic severe AS.
• Patients were grouped by guidewire type: 0.035" hydrophilic (n=253) vs. 0.038" fiber-core straight TEF (n=284).
• Primary outcomes included CVA within 24 hours and one month; secondary outcomes included pacemaker implantation, myocardial infarction, and mortality.

Main Results:

• No statistically significant difference in CVA incidence at 24 hours (p=0.71) or one month (p=0.43) between guidewire groups.
• Similar non-significant findings for permanent pacemaker implantation, all-cause mortality, and myocardial infarction at one month.
• The study found no significant differences in key adverse events between the two guidewire types.

Conclusions:

• Guidewire selection (0.035" hydrophilic vs. 0.038" fiber-core) for AV crossing during TAVR is not associated with significant differences in CVA rates.
• Major adverse clinical outcomes were comparable between the guidewire groups.
• Guidewire choice for AV crossing in TAVR may be left to operator preference without compromising cerebrovascular safety.