Export file:


  • RIS(for EndNote,Reference Manager,ProCite)
  • BibTex
  • Text


  • Citation Only
  • Citation and Abstract

Incidence and Prevention of Strokes in TAVI

Sones Cardiac Catheterization Laboratory, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, USA

Special Issues: Safety and outcomes of current TAVI devices

Transcatheter aortic valve implantation (TAVI) is now a widely adopted option for many inoperable and high risk patients with severe aortic valve stenosis, and clinical trials continue to show great benefit with regards to mortality and major cardiovascular endpoints. As the technology continues to expand and possibly grow to include intermediate and low risk populations, investigators have remained focused on efforts to reduce the risk of peri-procedural complications, of which neurologic events remain some of the most feared. Fortunately, contemporary studies have shown a significant decline in the risk of stroke with TAVI as compared to early clinical trials, and no difference when compared to surgical aortic valve replacement in the most recent trials. This review will focus on current methods for diagnosing, defining, and quantifying the effect of stroke after TAVI, explore the evidence with regards to stroke risk in various populations undergoing these procedures, discuss possible mechanisms for both early and late neurologic events after TAVI, and discuss strategies for both pharmacologic and device based embolic protection during these procedures.
  Article Metrics

Keywords TAVI; TAVR; transcatheter aortic valve implantation; stroke; embolic protection device; anti-platelet; anti-coagulation

Citation: Brandon M. Jones, E. Murat Tuzcu, Amar Krishnaswamy, Samir R. Kapadia. Incidence and Prevention of Strokes in TAVI. AIMS Medical Science, 2015, 2(1): 51-64. doi: 10.3934/medsci.2015.1.51


  • 1. Adams DH, Popma JJ, Reardon MJ, et al. (2014) Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med 370: 1790-1798.    
  • 2. Leon MB, Smith CR, Mack M, et al. (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363: 1597-1607.    
  • 3. Popma JJ, Adams DH, Reardon MJ, et al. (2014) Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery. J Am Coll Cardiol 63: 1972-1981.    
  • 4. Smith CR, Leon MB, Mack MJ, et al. (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364: 2187-2198.    
  • 5. O'Brien SM, Shahian DM, Filardo G, et al. (2009) The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2--isolated valve surgery. Ann Thorac Surg 88: S23-42.    
  • 6. Messe SR, Acker MA, Kasner SE, et al. (2014) Stroke after aortic valve surgery: results from a prospective cohort. Circulation 129: 2253-2261.    
  • 7. Leon MB, Piazza N, Nikolsky E, et al. (2011) Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the Valve Academic Research Consortium. Eur Heart J 32: 205-217.    
  • 8. Kappetein AP, Head SJ, Genereux P, et al. (2012) Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. Eur Heart J 33: 2403-2418.    
  • 9. Spaziano M, Francese DP, Leon MB, et al. (2014) Imaging and functional testing to assess clinical and subclinical neurological events after transcatheter or surgical aortic valve replacement: a comprehensive review. J Am Coll Cardiol 64: 1950-1963.    
  • 10. Eifert S, Reichenspurner H, Pfefferkorn T, et al. (2003) Neurological and neuropsychological examination and outcome after use of an intra-aortic filter device during cardiac surgery. Perfusion 18 Suppl 1: 55-60.
  • 11. Alassar A, Roy D, Valencia O, et al. (2013) Cerebral embolization during transcatheter aortic valve implantation compared with surgical aortic valve replacement (abstr.). Interact Cardiovasc Thorac Surg 17: S134-S135.
  • 12. Jones BM, Tuzcu EM, Krishnaswamy A, et al. (2015) Neurologic events after transcatheter aortic valve replacement. Interventional Cardiology Clinics 4: 83-93.    
  • 13. Hauville C, Ben-Dor I, Lindsay J, et al. (2012) Clinical and silent stroke following aortic valve surgery and transcatheter aortic valve implantation. Cardiovasc Revasc Med 13: 133-140.    
  • 14. Bucerius J, Gummert JF, Borger MA, et al. (2003) Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients. Ann Thorac Surg 75: 472-478.    
  • 15. Thourani VH, Ailawadi G, Szeto WY, et al. (2011) Outcomes of surgical aortic valve replacement in high-risk patients: a multiinstitutional study. Ann Thorac Surg 91: 49-55; discussion 55-46.    
  • 16. Eggebrecht H, Schmermund A, Voigtlander T, et al. (2012) Risk of stroke after transcatheter aortic valve implantation (TAVI): a meta-analysis of 10,037 published patients. EuroIntervention8: 129-138.
  • 17. Miller DC, Blackstone EH, Mack MJ, et al. (2012) Transcatheter (TAVR) versus surgical (AVR) aortic valve replacement: occurrence, hazard, risk factors, and consequences of neurologic events in the PARTNER trial. J Thorac Cardiovasc Surg 143: 832-843 e813.    
  • 18. Tay EL, Gurvitch R, Wijesinghe N, et al. (2011) A high-risk period for cerebrovascular events exists after transcatheter aortic valve implantation. JACC Cardiovasc Interv 4: 1290-1297.    
  • 19. Stortecky S, Windecker S, Pilgrim T, et al. (2012) Cerebrovascular accidents complicating transcatheter aortic valve implantation: frequency, timing and impact on outcomes. EuroIntervention 8: 62-70.    
  • 20. Nuis RJ, Van Mieghem NM, Schultz CJ, et al. (2012) Frequency and causes of stroke during or after transcatheter aortic valve implantation. Am J Cardiol 109: 1637-1643.    
  • 21. Mack MJ, Brennan JM, Brindis R, et al. (2013) Outcomes following transcatheter aortic valve replacement in the United States. JAMA 310: 2069-2077.    
  • 22. Hamon M, Baron JC, Viader F (2008) Periprocedural stroke and cardiac catheterization. Circulation 118: 678-683.    
  • 23. Omran H, Schmidt H, Hackenbroch M, et al. (2003) Silent and apparent cerebral embolism after retrograde catheterisation of the aortic valve in valvular stenosis: a prospective, randomised study. Lancet 361: 1241-1246.    
  • 24. Letac B, Cribier A, Koning R, et al. (1988) Results of percutaneous transluminal valvuloplasty in 218 adults with valvular aortic stenosis. Am J Cardiol 62: 598-605.    
  • 25. Hahn RT, Pibarot P, Webb J, et al. (2014) Outcomes With Post-Dilation Following Transcatheter Aortic Valve Replacement: The PARTNER I Trial (Placement of Aortic Transcatheter Valve). JACC Cardiovasc Interv 7: 781-789.    
  • 26. Amat-Santos IJ, Rodes-Cabau J, Urena M, et al. (2012) Incidence, predictive factors, and prognostic value of new-onset atrial fibrillation following transcatheter aortic valve implantation. J Am Coll Cardiol 59: 178-188.    
  • 27. Shults C, Gunter R, Thourani VH (2012) The versatility of transapical access: Will it lead to a completely new approach to valvular therapy? Ann Cardiothorac Surg 1: 220-223.
  • 28. Athappan G, Gajulapalli RD, Sengodan P, et al. (2014) Influence of transcatheter aortic valve replacement strategy and valve design on stroke after transcatheter aortic valve replacement: a meta-analysis and systematic review of literature. J Am Coll Cardiol 63: 2101-2110.    
  • 29. Abdel-Wahab M, Mehilli J, Frerker C, et al. (2014) Comparison of balloon-expandable vs self-expandable valves in patients undergoing transcatheter aortic valve replacement: the CHOICE randomized clinical trial. JAMA 311: 1503-1514.    
  • 30. Nombela-Franco L, Rodes-Cabau J, DeLarochelliere R, et al. (2012) Predictive factors, efficacy, and safety of balloon post-dilation after transcatheter aortic valve implantation with a balloon-expandable valve. JACC Cardiovasc Interv 5: 499-512.
  • 31. Whitlock RP, Sun JC, Fremes SE, et al. (2012) Antithrombotic and thrombolytic therapy for valvular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141: e576S-600S.
  • 32. Holmes DR, Jr., Mack MJ, Kaul S, et al. (2012) 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol 59: 1200-1254.    
  • 33. Ussia GP, Scarabelli M, Mule M, et al. (2011) Dual antiplatelet therapy versus aspirin alone in patients undergoing transcatheter aortic valve implantation. Am J Cardiol 108: 1772-1776.    
  • 34. Sergie Z, Lefevre T, Van Belle E, et al. (2013) Current periprocedural anticoagulation in transcatheter aortic valve replacement: could bivalirudin be an option? Rationale and design of the BRAVO 2/3 studies. J Thromb Thrombolysis 35: 483-493.    
  • 35. Freeman M, Barbanti M, Wood DA, et al. (2014) Cerebral events and protection during transcatheter aortic valve replacement. Catheter Cardiovasc Interv.
  • 36. Nietlispach F, Wijesinghe N, Gurvitch R, et al. (2010) An embolic deflection device for aortic valve interventions. JACC Cardiovasc Interv 3: 1133-1138.    
  • 37. Onsea K, Agostoni P, Samim M, et al. (2012) First-in-man experience with a new embolic deflection device in transcatheter aortic valve interventions. EuroIntervention 8: 51-56.    
  • 38. Naber CK, Ghanem A, Abizaid AA, et al. (2012) First-in-man use of a novel embolic protection device for patients undergoing transcatheter aortic valve implantation. EuroIntervention 8: 43-50.    
  • 39. Banbury MK, Kouchoukos NT, Allen KB, et al. (2003) Emboli capture using the Embol-X intraaortic filter in cardiac surgery: a multicentered randomized trial of 1,289 patients. Ann Thorac Surg 76: 508-515; discussion 515.    
  • 40. Ye J, Webb JG (2014) Embolic capture with updated intra-aortic filter during coronary artery bypass grafting and transaortic transcatheter aortic valve implantation: First-in-human experience. J Thorac Cardiovasc Surg.
  • 41. Etienne PY, Papadatos S, Pieters D, et al. (2011) Embol-X intraaortic filter and transaortic approach for improved cerebral protection in transcatheter aortic valve implantation. Ann Thorac Surg 92: e95-96.    


This article has been cited by

  • 1. W. Benjamin Kratzert, Alex Mladenow, Eva K. Boyd, Komal Patel, Perioperative Management of Transcatheter Aortic Valve Replacement: Current Advancements and Controversies, Current Anesthesiology Reports, 2015, 5, 4, 474, 10.1007/s40140-015-0134-5

Reader Comments

your name: *   your email: *  

Copyright Info: 2015, Samir R. Kapadia, et al., licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution Licese (http://creativecommons.org/licenses/by/4.0)

Download full text in PDF

Export Citation

Copyright © AIMS Press All Rights Reserved