title: Stroke complicating transcatheter aortic valve implantation: incidence, risk factors and outcome.
abstract: BACKGROUND
  Transcatheter aortic valve implantation is a novel therapeutic option for patients at high risk for surgical heart valve replacement that carries a risk for periprocedural stroke.
  
  
  METHODS
  Consecutive patients undergoing transcatheter aortic valve implantation with the self-expandable Medtronic-Corevalve Revalving system were included in a single-centre prospective database. Strokes complicating transcatheter aortic valve implantation in the first five-days following the procedure were documented, and the differences between patients with and without stroke were studied.
  
  
  RESULTS
  Seventy-two patients (32 men, mean age 80·5 ± 6·2) underwent transcatheter aortic valve implantation from September 2008 to April 2011. Of these, eight (11%) had focal neurological deficits in the periprocedural period (three transient ischaemic attacks, five strokes of which three were minor, one moderate, and one major). Patients with stroke/transient ischaemic attacks did not differ from those without cerebral ischaemia in baseline criteria or procedural variables. Six of the events were believed to be embolic resulting from dislodgement of calcific material from the aortic valve, and one transient ischaemic attack was secondary to hypoperfusion during severe bradycardia. One patient with basilar occlusion died, but the remaining six patients survived and all had a modified Rankin score ≤2 at 90 days. None of the patients had a recurrent stroke during follow-up.
  
  
  CONCLUSIONS
  Periprocedural cerebral ischaemia following transcatheter aortic valve implantation is not uncommon, but most patients have good outcomes. There was no particular pre-transcatheter aortic valve implantation or procedural risk factor profile that increased the risk for periprocedural stroke. Further studies are warranted to examine whether patients that are at higher risk for developing stroke after transcatheter aortic valve implantation can be identified.
authors.affiliation: Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. leker@hadassah.org.il
authors.forename: Ronen R
authors.initials: RR
authors.lastname: Leker
authors.forename: Roni
authors.initials: R
authors.lastname: Eichel
authors.forename: Ami
authors.initials: A
authors.lastname: Verber
authors.forename: Jose E
authors.initials: JE
authors.lastname: Cohen
authors.forename: Chaim
authors.initials: C
authors.lastname: Lotan
authors.forename: Haim D
authors.initials: HD
authors.lastname: Danenberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D002404:Catheterization; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D016896:Treatment Outcome