title: Frequency and causes of stroke during or after transcatheter aortic valve implantation.
abstract: Transcatheter aortic valve implantation (TAVI) is invariably associated with the risk of clinically manifest transient or irreversible neurologic impairment. We sought to investigate the incidence and causes of clinically manifest stroke during TAVI. A total of 214 consecutive patients underwent TAVI with the Medtronic-CoreValve System from November 2005 to September 2011 at our institution. Stroke was defined according to the Valve Academic Research Consortium recommendations. Its cause was established by analyzing the point of onset of symptoms, correlating the symptoms with the computed tomography-detected defects in the brain, and analyzing the presence of potential coexisting causes of stroke, in addition to a multivariate analysis to determine the independent predictors. Stroke occurred in 19 patients (9%) and was major in 10 (5%), minor in 3 (1%), and transient (transient ischemic attack) in 6 (3%). The onset of symptoms was early (≤24 hours) in 8 patients (42%) and delayed (>24 hours) in 11 (58%). Brain computed tomography showed a cortical infarct in 8 patients (42%), a lacunar infarct in 5 (26%), hemorrhage in 1 (5%), and no abnormalities in 5 (26%). Independent determinants of stroke were new-onset atrial fibrillation after TAVI (odds ratio 4.4, 95% confidence interval 1.2 to 15.6), and baseline aortic regurgitation grade III or greater (odds ratio 3.2, 95% confidence interval 1.1 to 9.3). In conclusion, the incidence of stroke was 9%, of which >1/2 occurred >24 hours after the procedure. New-onset atrial fibrillation was associated with a 4.4-fold increased risk of stroke. In conclusion, these findings indicate that improvements in postoperative care after TAVI are equally, if not more, important for the reduction of periprocedural stroke than preventive measures during the procedure.
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Rutger-Jan
authors.initials: RJ
authors.lastname: Nuis
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: Van Mieghem
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Schultz
authors.forename: Adriaan
authors.initials: A
authors.lastname: Moelker
authors.forename: Robert M
authors.initials: RM
authors.lastname: van der Boon
authors.forename: Robert Jan
authors.initials: RJ
authors.lastname: van Geuns
authors.forename: Aad
authors.initials: A
authors.lastname: van der Lugt
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koudstaal
authors.forename: Peter P
authors.initials: PP
authors.lastname: de Jaegere
mesh_terms: D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000453:epidemiology; D001281:Atrial Fibrillation / Q000453:epidemiology; D001921:Brain / Q000000981:diagnostic imaging; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging; D006493:Heparin / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D008297:Male; D015999:Multivariate Analysis; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin