Clinical Predictors for Procedural Stroke and Implications for Embolic Protection Devices during TAVR: Results from the Multicenter Transcatheter Aortic Valve Replacement In-Hospital Stroke (TASK) Study

Anat Berkovitch, Amit Segev, Elad Maor, Alexander Sedaghat, Ariel Finkelstein, Matteo Saccocci, Ran Kornowski, Azeem Latib, Jose M.De La Torre Hernandez, Lars Søndergaard, Darren Mylotte, Niels Van Royen, Azfar G. Zaman, Pierre Robert, Jan Malte Sinning, Arie Steinvil, Francesco Maisano, Katia Orvin, Gianmarco Iannopollo, Dae Hyun LeeOle De Backer, Federico Mercanti, Kees van der Wulp, Joy Shome, Didier Tchétché, Israel M. Barbash

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Data to support the routine use of embolic protection devices for stroke prevention during transcatheter aortic valve replacement (TAVR) are controversial. Identifying patients at high risk for peri-procedural cerebrovascular events may facilitate effective patient selection for embolic protection devices during TAVR. Aim: To generate a risk score model for stratifying TAVR patients according to peri-procedural cerebrovascular events risk. Methods and results: A total of 8779 TAVR patients from 12 centers worldwide were included. Peri-procedural cerebrovascular events were defined as an ischemic stroke or a transient ischemic attack occurring ≤24 h from TAVR. The peri-procedural cerebrovascular events rate was 1.4% (n = 127), which was independently associated with 1-year mortality (hazards ratio (HR) 1.78, 95% confidence interval (CI) 1.06–2.98, p < 0.028). The TASK risk score parameters were history of stroke, use of a non-balloon expandable valve, chronic kidney disease, and peripheral vascular disease, and each parameter was assigned one point. Each one-point increment was associated with a significant increase in peri-procedural cerebrovascular events risk (OR 1.96, 95% CI 1.56–2.45, p < 0.001). The TASK score was dichotomized into very-low, low, intermediate, and high (0, 1, 2, 3–4 points, respectively). The high-risk TASK score group (OR 5.4, 95% CI 2.06–14.16, p = 0.001) was associated with a significantly higher risk of peri-procedural cerebrovascular events compared with the low TASK score group. Conclusions: The proposed novel TASK risk score may assist in the pre-procedural risk stratification of TAVR patients for peri-procedural cerebrovascular events.

Original languageEnglish (US)
Article number1056
JournalJournal of Personalized Medicine
Volume12
Issue number7
DOIs
StatePublished - Jul 2022
Externally publishedYes

Keywords

  • aortic stenosis
  • stroke
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Medicine (miscellaneous)

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