Stroke after TAVR: New data helps cardiologists detect early warning signs

Diabetes, a lower LVEF, a lower estimated glomerular filtration rate, moderate-to-severe mitral regurgitation, critical status and a EuroSCORE II higher than 4% were all more common among patients who experienced a stroke within 30 days of TAVR. In addition, a history of neurological dysfunction, a bicuspid aortic valve and a Geriatric Status Scale of two or three were all more common in patients who experienced a stroke within six months.

The authors ran additional analyses to determine which of these patient factors was associated with a greater risk of post-TAVR stroke. Overall, diabetes and a LVEF less than 50% were defined as “independent predictors of 30-day stroke.” Diabetes, a history of neurological dysfunction and critical status were predictive of a stroke within six months of TAVR.

Meanwhile, the TAVR system used did not impact a patient’s overall risk of stroke. In fact, the only significant procedural factor consistently linked to a heightened stroke risk was aortic valve predilatation, which was performed in 43.3% of TAVR cases. Gorla and colleagues emphasized that the potential link between aortic valve predilatation and post-stroke TAVR remains complicated.

“The decision to perform predilatation often relies on the operator’s choice, mainly based on the degree of calcification of the aortic valve, which may itself be an independent predictor for thromboembolic events,” the authors wrote. “Thus, although statistically significant, a causal relationship between predilatation and the risk of stroke cannot be clearly expressed.”

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