Neurological Events Following Transcatheter Aortic Valve Replacement and Their Predictors
Authors: Kleiman Neal S. , Maini Brijeshwar J. , Reardon Michael J. , Conte John , Katz Stanley , Rajagopal Vivek , Kauten James , Hartman Alan , McKay Raymond , Hagberg Robert , Huang Jian , Popma Jeffrey , Adams David , Ad Niv , Aharonian Vicken , Anderson William D. , Applegate Robert , Bafi Amar , Bajwa Tanvir , Bakhos Mamdouh , Ball Stephen , Batra Sanjay , Beohar Nirat , Brachinsky William , Brinster Derek , Brown John , Byrne John , Byrne Timothy , Casale Alfred , Caskey Michael , Chawla Atul , Cohen Howard , Coselli Joseph , Costa Marco , Cheatham John , Chetcuti Stanley J. , Crestanello Juan , Davis Thomas , Michael Deeb G. , Diez Jose , Dauerman Harold , Elefteriades John , Fail Peter , Feinberg Edgar , Fontana Gregory , Forrest John L. , Galloway Aubrey , Giacomini John , Gleason Thomas G. , Guadiani Vincent , Harrison J. Kevin , Hebeler Robert , Heimansohn David , Heiser John , Heller Louis , Henry Scott , Hermiller James , Hockmuth David , Hughes G. Chad , Joye James , Kafi Ali , Kar Biswajit , Khabbaz Kamal , Kipperman Robert , Kliger Chad , Kon Neal , Lamelas Joseph , Lee Joon Sup , Leya Ferdinand , Londono Juan Carlos , Macheers Steven , Mangi Abeel , de Marchena Eduardo , Markowitz Alan , Matthews Ray , Merhi William , Mumtaz Mubashir , O’Hair Daniel , Petrossian George , Pfeffer Thomas , Raybuck Bryan , Resar Jon , Robbins Mark , Robbins Robert , Robinson Newell , Ring Michael , Salerno Tomas , Schreiber Theodore , Schmoker Joseph , Sharma Samin , Siwek Lee , Skelding Kimberly , Slater James , Starnes Vaughn , Stoler Robert , Subramanian Valavanur , Tadros Peter , Thompson Craig , Waksman Ron , Watson Daniel , Yakubov Steven , Zhao David , Zorn George L. 
Published: September 2016

Background—

The risk for stroke after transcatheter aortic valve replacement (TAVR) is an important concern. Identification of predictors for stroke is likely to be a critical factor aiding patient selection and management as TAVR use becomes widespread.

Methods and Results—

Patients enrolled in the CoreValve US Extreme Risk and High Risk Pivotal Trials or Continued Access Study treated with the self-expanding CoreValve bioprosthesis were included in this analysis. The 1-year stroke rate after TAVR was 8.4%. Analysis of the stroke hazard rate identified an early phase (0–10 days; 4.1% of strokes) and a late phase (11–365 days; 4.3% of strokes). Baseline predictors of early stroke included National Institutes of Health stroke scale score >0, prior stroke, prior transient ischemic attack, peripheral vascular disease, absence of prior coronary artery bypass surgery, angina, low body mass index (<21 kg/m
2
), and falls within the past 6 months. Significant procedural predictors were total time in the catheterization laboratory or operating room, delivery catheter in the body time, rapid pacing used during valvuloplasty, and repositioning of the prosthesis. Predictors of stroke between 11 and 365 days were small body surface area, severe aortic calcification, and falls within the past 6 months. There were no significant imaging predictors of early or late stroke.

Conclusions—

Predictors of early stroke after TAVR included clinical and procedural factors; predictors of later stroke were limited to patient but not anatomic characteristics. These findings indicate that further refinement of imaging to identify anatomic factors predisposing to embolization may help improve stroke prediction in patients undergoing TAVR.

Clinical Trial Registrations—

URL:
http://www.clinicaltrials.gov
. Unique identifiers: NCT01240902, NCT01531374.