title: Cerebrovascular accidents complicating transcatheter aortic valve implantation: frequency, timing and impact on outcomes.
abstract: OBJECTIVE
  Cerebrovascular accidents (CVA) are considered among the most serious adverse events after transcatheter aortic valve implantation (TAVI). The objective of the present study was to evaluate the frequency and timing of CVA after TAVI and to investigate the impact on clinical outcomes within 30 days of the procedure.
  
  
  RESULTS
  Between August 2007 and October 2011, 389 high-risk elderly patients with symptomatic severe aortic stenosis underwent TAVI via transfemoral, transapical or subclavian access. A total of 14 patients (3.6%) experienced at least one CVA within 30 days of follow-up and most events (74%) occurred within the first day of the procedure. Patients with CVA had an increased risk of all-cause (42.3% vs. 5.1%, ORadjusted 11.7, 95% CI 3.4-40.3, p<0.001) and cardiovascular mortality (38.4% vs. 4.6%, ORadjusted 10.5, 95% CI 2.9-37.8, p<0.001) compared to patients without CVA at 30 days of follow-up. Repeated device implantation attempts (ORadjusted 8.3, CI 2.1-33.3, p<0.003), chronic pulmonary disease (ORadjusted 4.7, CI 1.3-16.8, p=0.02) and body mass index <25 kg/m2 (ORadjusted 0.8, CI 0.7-0.9, p<0.01) emerged as independent predictors of periprocedural CVA.
  
  
  CONCLUSIONS
  Cerebrovascular accidents among patients undergoing TAVI occur predominantly during the periprocedural period, are associated with multiple implantation attempts of the bioprosthesis and significantly impair prognosis.
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Centre, Bern University Hospital, Bern, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Thomas
authors.initials: T
authors.lastname: Pilgrim
authors.forename: Dik
authors.initials: D
authors.lastname: Heg
authors.forename: Lutz
authors.initials: L
authors.lastname: Buellesfeld
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khattab
authors.forename: Christoph
authors.initials: C
authors.lastname: Huber
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.forename: Heinrich
authors.initials: H
authors.lastname: Mattle
authors.forename: Peter
authors.initials: P
authors.lastname: Jüni
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000401:mortality; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome