Risk factors predicting stroke after TAVR ‘inconsistent’
A single-center study suggests prior stroke and initial experience are independent risk factors for stroke within 30 days of transcatheter aortic valve replacement; however, no other factors emerged as predictors, researchers reported.
“To our knowledge, there are only few studies analyzing risk factors for stroke/transient ischemic attack after TAVR, which are predominantly based on registry data,” Lena K. Eschenbach, MD, of the department of cardiovascular surgery at the German Heart Centre, Munich, and colleagues wrote. “Although our patient cohort is smaller compared with most studies based on registry data, a single‐center design allows for study‐specific data collection and validation.”
In a retrospective database analysis, Eschenbach and colleagues analyzed data from 1,919 patients who underwent TAVR at the German Heart Centre in Munich from 2007 to 2017. The mean age of patients was 80 years and 52% were women. All strokes or TIAs within 30 days after TAVR were categorized according to the Valve Academic Research Consortium‐II criteria. Researchers assessed pre‐, intra‐ and postprocedural data.
Stroke or TIA after TAVR occurred in 3.9% of patients, with 1.9% considered disabling and 1.6% nondisabling. The predominant type of stroke were territorial ischemic lesions (82.4%), with primary bleeding in 4.4% and border zone infarctions in 4.4%. Left‐sided lesions were more common (45.6% left sided vs. 25% right sided) and 13.2% of the lesions were bilateral.
Researchers found the stroke/TIA rate was higher during the initial implantation phase and declined thereafter, with 33% detected within 24 hours after the procedure and 77% detected between day 2 and day 30.
In logistic regression analyses, prior stroke/TIA (OR = 1.84; P = .046) and the first 300 TAVR implantations (OR = 1.784; P = .04) influenced occurrence of stroke at 30 days. Age at the time of procedure was not associated with an increased risk for stroke.
Thirty‐day mortality was 13.2% in patients with stroke and 4.9% in patients without stroke (P = .005).
“In the present study, no other factor emerged as an important predictor for stroke,” the researchers wrote. “Carotid artery disease, nonfemoral access, age, porcelain aorta and balloon‐expandable valve type have been found to be risk factors in previous studies. However, we were not able to reproduce these findings in our multivariate risk factor analysis. In general, we noticed that the results among studies identifying risk factors for stroke after TAVR are relatively inconsistent.”
The researchers noted that only a minority of strokes in the cohort could be attributed to previous stroke before TAVR, adding that other patient characteristics or procedural details “are of little value to estimate the risk for periprocedural stroke in TAVR.”
“It seems that the occurrence of stroke cannot be predicted by risk factors alone,” the researchers wrote.
Collapse