Carotid Disease and Stroke After Transcatheter Aortic Valve Replacement

Lansky, Alexandra J.; Ghare, Mohammed Imran; Pietras, Cody

doi:10.1161/circinterventions.118.006826

Cited by 6 publications

(2 citation statements)

References 14 publications

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“…So, even if we try to reduce embolism‐related stroke events through the use of CEPD, these residual factors may still contribute to stroke risk on short‐ or long‐term follow‐up. 29 In addition, delayed periprocedural events that increase the risk of stroke including new onset atrial fibrillation, valve thrombosis, and plaque embolization would be unlikely to be affected by the intraprocedural use of CEPD. 30 Furthermore, in real‐world practices unfavorable anatomy may preclude CEPD use in some patients especially those with poor radial access or torturous great vessels with high atherosclerotic burden.…”

Section: Discussionmentioning

confidence: 99%

Role of Cerebral Embolic Protection Devices in Patients Undergoing Transcatheter Aortic Valve Replacement: An Updated Meta‐Analysis

Kaur,

Dhaliwal,

Sohal

et al. 2024

JAHA

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Background Cerebral embolic protection devices (CEPD) capture embolic material in an attempt to reduce ischemic brain injury during transcatheter aortic valve replacement. Prior reports have indicated mixed results regarding the benefits of these devices. With new data emerging, we performed an updated meta‐analysis examining the effect of CEPD during transcatheter aortic valve replacement on various clinical, neurological, and safety parameters. Methods and Results A comprehensive review of electronic databases was performed comparing CEPD and no‐CEPD in transcatheter aortic valve replacement. Primary clinical outcome was all‐cause stroke. Secondary clinical outcomes were disabling stroke and all‐cause mortality. Neurological outcomes included worsening of the National Institutes of Health Stroke Scale score, Montreal Cognitive Assessment score from baseline at discharge, presence of new ischemic lesions, and total lesion volume on neuroimaging. Safety outcomes included major or minor vascular complications and stage 2 or 3 acute kidney injury. Seven randomized controlled trials with 4016 patients met the inclusion criteria. There was no statistically significant difference in the primary clinical outcome of all‐cause stroke; secondary clinical outcomes of disabling stroke, all‐cause mortality, neurological outcomes of National Institutes of Health Stroke Scale score worsening, Montreal Cognitive Assessment worsening, presence of new ischemic lesions, or total lesion volume on diffusion‐weighted magnetic resonance imaging between CEPD versus control groups. There was no statistically significant difference in major or minor vascular complications or stage 2 or 3 acute kidney injury between the groups. Conclusions The use of CEPD in transcatheter aortic valve replacement was not associated with a statistically significant reduction in the risk of clinical, neurological, and safety outcomes.

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Section: Discussionmentioning

confidence: 99%

Role of Cerebral Embolic Protection Devices in Patients Undergoing Transcatheter Aortic Valve Replacement: An Updated Meta‐Analysis

Kaur,

Dhaliwal,

Sohal

et al. 2024

JAHA

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“…In the Placement of Aortic Transcatheter Valve (PARTNER) 1A trial, operative candidates at high risk who were randomized to TAVR had substantially increased risk of stroke or transient ischemic attack at 30 days compared with those who underwent SAVR (19 patients [5.5%] vs 8 patients [2.4%]; P = .04), while stroke rates after TAVR in the recent trial of intermediate- or low-risk patients are lower than after SAVR . Nevertheless, stroke remains a significant complication of TAVR, associated with a 2-fold to 9-fold mortality risk . Several multicenter registries have demonstrated that roughly 50% of stroke events occur in the first 30 days after TAVR (eTable in the Supplement), most are ischemic strokes, and 25% occur within 24 hours after TAVR .…”

Section: Timing and Mechanism Of Strokementioning

confidence: 99%

Adjunctive Antithrombotic Therapy for Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

et al. 2020

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IMPORTANCETranscatheter aortic valve replacement (TAVR) is an established alternative to surgery for patients with severe symptomatic aortic stenosis. Adjunctive antithrombotic therapy used to mitigate thrombotic risks in patients undergoing TAVR must be balanced against bleeding complications, since both are associated with increased mortality.OBSERVATION Stroke risk associated with TAVR is lower than that associated with surgical aortic valve replacement in recent trials including patients at intermediate or low risk, but it is constant beginning at the time of implant and accrues over time based on patient risk factors. Patients with aortic stenosis undergoing TAVR also have a sizable risk of life-threatening or major bleeding. Although dual antiplatelet therapy for 3 to 6 months after TAVR is the guideline-recommended regimen, this practice is not well supported by current evidence. In patients with no indication for oral anticoagulation, current registry-based evidence suggests that single antiplatelet therapy may be safer than dual antiplatelet therapy. Similarly, oral anticoagulation monotherapy appears superior to anticoagulation plus antiplatelet therapy in those where oral anticoagulant use is indicated. To date, no risk prediction models have been established to guide antithrombotic therapy.CONCLUSIONS AND RELEVANCE Despite the growing volume of TAVR procedures to treat patients with severe aortic stenosis, evidence for adjunctive antithrombotic therapy remains rather scarce. Ongoing clinical trials will provide better understanding to guide antithrombotic therapy.

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