Self-expandable transcatheter aortic valve replacement is associated with frequent periprocedural stroke detected by diffusion-weighted magnetic resonance imaging. 
Little evidence is available regarding the risk of peri-procedural stroke detected by diffusion-weighted magnetic resonance imaging (DW-MRI) after transcatheter aortic valve replacement (TAVR).  Our purpose was to evaluate stroke risk after TAVR using DW-MRI by enrolling consecutive patients who underwent transfemoral TAVR and post-procedural DW-MRI.  We prospectively enrolled 113 consecutive patients who underwent transfemoral TAVR and post-procedural DW-MRI.  We used balloon-expandable valves as first-line therapy and selected self-expandable valves only for patients with narrow sinotubular junctions or annuli.  We set the primary endpoint as the number of high intensity areas (HIA) detected by DW-MRI regardless of the size of the area.  To evaluate the risks of the primary endpoint, we employed a multivariable linear regression model, setting the primary endpoint as an objective variable and patient and clinical backgrounds as explanatory variables.  Median patient age was 84 years, and 36.3% were men.  Ninety-three patients underwent balloon-expandable TAVR and 20 underwent self-expandable TAVR.  Symptomatic stroke occurred in 6 (5.3%) whereas asymptomatic stroke occurred in 59 (52.2%) patients.  The incidence of symptomatic and total stroke was higher in patients who underwent self-expandable TAVR than those who underwent balloon-expandable TAVR (30.0% vs. 0.0%, p<0.001 and 90.0% vs. 50.5%, p=0.001, respectively).  A multivariable linear regression model demonstrated an increased primary endpoint when self-expandable TAVR was performed (p<0.001).  The other covariates had no significant relationship to the primary endpoint.  Akaike information criterion-based stepwise statistical model selection revealed that valve type was the only explanatory variable for the best predictive model.  Self-expandable valves were associated with increased numbers of HIA on DW-MRI after TAVR in patients with severe aortic stenosis.