Transcatheter aortic valve implantation and cerebrovascular events: the current state of the art

Transcatheter aortic valve implantation (TAVI) has revolutionized the care of high‐risk patients with severe calcific aortic stenosis. Those considered at high or prohibitive risk of major adverse outcomes with open surgical aortic valve replacement may now be offered an alternative less‐invasive th...

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Bibliographic Details
Published in:Annals of the New York Academy of Sciences 2012-04, Vol.1254 (1), p.151-163
Main Authors: Hynes, Brian G., Rodés-Cabau, Josep
Format: Article
Language:English
Subjects:
aortic stenosis
Aortic Valve
Brain Ischemia - etiology
Brain Ischemia - prevention & control
Cardiology
Cerebrovascular Disorders - diagnosis
Cerebrovascular Disorders - etiology
Cerebrovascular Disorders - prevention & control
Diffusion Magnetic Resonance Imaging
Heart attacks
Heart Valve Prosthesis Implantation - adverse effects
Heart Valve Prosthesis Implantation - methods
Humans
Intracranial Embolism - etiology
Intracranial Embolism - physiopathology
Minimally Invasive Surgical Procedures - adverse effects
Minimally Invasive Surgical Procedures - methods
Prognosis
Registries
stroke
transcatheter aortic valve implantation
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Summary:Transcatheter aortic valve implantation (TAVI) has revolutionized the care of high‐risk patients with severe calcific aortic stenosis. Those considered at high or prohibitive risk of major adverse outcomes with open surgical aortic valve replacement may now be offered an alternative less‐invasive therapy. Despite the rapid evolution and clinical application of this new technology, recent studies have raised concerns about adverse cerebrovascular event rates in patients undergoing TAVI. In this review, we explore the current data both in relation to procedure‐related silent cerebrovascular ischemic events, as well as clinically apparent stroke. The timing of neurological events and their prognostic implications are also examined. Finally, potential mechanisms of TAVI‐related cerebrovascular injury are described, in addition to efforts to minimize their occurrence.
ISSN:0077-8923
1749-6632
DOI:10.1111/j.1749-6632.2012.06477.x