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

Transcatheter aortic valve replacement (TAVR) has become an established minimally invasive treatment for patients with severe symptomatic aortic stenosis (AS), particularly those at high surgical risk. One procedural step involves advancing a guidewire across the aortic valve (AV) into the left ventricle (LV). Prior studies have shown that manipulation of calcified structures, vascular plaque embolization, and prolonged procedural time may increase the risk of cerebrovascular accidents (CVA) associated with TAVR. This study aimed to compare the incidence of CVA and other periprocedural outcomes based on the type of guidewire used to cross the AV during TAVR.

We conducted a retrospective analysis of 537 patients who had undergone TAVR for symptomatic severe AS between July 2018 and July 2023 at our healthcare facility. Patients were divided into two groups: those receiving a 0.035" hydrophilic guidewire (n = 253) versus a 0.038" fiber-core straight TEF guidewire (n = 284) for AV crossing. Baseline demographics, procedural characteristics, and outcomes were compared between groups. The primary outcomes were CVA within 24 hours and within one month. Secondary outcomes included permanent pacemaker (PPM) implantation, myocardial infarction (MI), and all-cause mortality at one month.

There were no statistically significant differences in the incidence of CVA between the hydrophilic and fiber-core wire groups at 24 hours (p = 0.71) or one month (p = 0.43). Similarly, there were no significant differences in PPM implantation at 24-48 hours (p = 0.23) or at one month (p = 0.42), in one-month all-cause mortality (p = 0.29), or in MI within one month (p = 1.00).

The type of guidewire used to cross the AV during TAVR, whether 0.035" hydrophilic or 0.038" fiber-core straight TEF, was not associated with significant differences in the incidence of CVA or other major adverse clinical outcomes. These findings suggest that guidewire selection for AV crossing may be based on operator preference without compromising cerebrovascular safety.