title: A high-risk period for cerebrovascular events exists after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  This study assesses if there exists a high-risk period for cerebrovascular events (CeV) after transcatheter aortic valve implantation (TAVI).
  
  
  BACKGROUND
  Even though acute strokes after TAVI have been described, it is uncertain if stroke rates continue to remain high in the early months after TAVI. Furthermore, the optimal dose and duration of thromboprophylaxis is unclear.
  
  
  METHODS
  Patients who underwent TAVI were evaluated at baseline, at discharge, at 1 and 6 months, and yearly. Risk factors for CeV events, procedural details, and antithrombotic therapy were recorded. Outcomes assessed were CeV events and death. The timing of such events, predictors, and impact on survival were analyzed.
  
  
  RESULTS
  A total of 253 patients were assessed. Median age was 85 years. The median Society of Thoracic Surgeons score was 8.1% (interquartile range [IQR]: 5.5% to 12.0%). Risk factors included smoking (47%), hypertension (70%), dyslipidemia (66%), and diabetes mellitus (25%). Twenty-three percent had known cerebrovascular disease and 39% had atrial fibrillation. Median follow-up was 455 days (IQR: 160 to 912 days) at which time 23 patients experienced a CeV event. The incidence was highest in the first 24 h but remained high for 2 months. In-hospital mortality rate after a CeV event was 21%. A prior history of CeV disease was an independent predictor of an event (hazard ratio: 4.23, 95% CI: 1.60 to 11.11, p = 0.004).
  
  
  CONCLUSIONS
  The incidence of CeV events is highest within 24 h of TAVI, but this risk may remain elevated for up to 2 months. A prior history of cerebrovascular disease is an independent predictor. This may have implications for patient selection and antithrombotic strategies.
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
authors.forename: Edgar L W
authors.initials: EL
authors.lastname: Tay
authors.forename: Ronen
authors.initials: R
authors.lastname: Gurvitch
authors.forename: Namal
authors.initials: N
authors.lastname: Wijesinghe
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.forename: Fabian
authors.initials: F
authors.lastname: Nielispach
authors.forename: David
authors.initials: D
authors.lastname: Wood
authors.forename: Anson
authors.initials: A
authors.lastname: Cheung
authors.forename: Jian
authors.initials: J
authors.lastname: Ye
authors.forename: Samuel V
authors.initials: SV
authors.lastname: Lichtenstein
authors.forename: Ronald
authors.initials: R
authors.lastname: Carere
authors.forename: Christopher
authors.initials: C
authors.lastname: Thompson
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000628:therapy*; D001955:British Columbia; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000209:etiology* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome