Key result
Prior cerebrovascular events, PAD, CKD, and self-expandable valves link to up to ~52% higher post-TAVI stroke risk.
Why the study?
Stroke is a devastating complication of TAVI affecting outcomes and mortality, and identifying risk factors is essential to optimize patient selection and management.
What are the patient and procedural risk factors for stroke within 30 days following TAVI?
What are the patient and procedural risk factors for stroke within 30 days following TAVI?
Prior cerebrovascular events, peripheral artery disease, chronic kidney disease, and the use of self-expandable valves are significant risk factors for 30-day stroke following TAVI.
These predictors warrant enhanced pre-TAVI risk stratification and stroke prevention; reinforces consensus on established patient and procedural factors.
Background Stroke is a devastating complication of transcatheter valve implantation (TAVI), affecting both patient outcomes and mortality rates. Identifying risk factors for stroke will be essential in optimizing patient selection and management as TAVI becomes more widely adopted. Purpose This systematic review and meta-analysis aim to evaluate risk factors for stroke following TAVI. Methods A systematic literature search including PubMed, Scopus, and Cochrane databases was conducted to identify studies reporting stroke events up to 30 days post-procedure and associated patient/procedure-related risk factors following TAVI. A meta-analysis with risk ratios (RR) was performed using random-effects model, and heterogeneity was assessed using the I² statistic. Results A total of 52 studies encompassing 293,821 patients were included in the meta-analysis. Patient characteristics were defined as the primary endpoints and procedural details as the secondary endpoints. Significant predictors of stroke included prior cerebrovascular events (CVE) (RR: 1.52; 95%CI: 1.31 – 1.76; I² = 51%), peripheral artery disease (PAD) (RR: 1.34; 95%CI: 1.11 – 1.61; I² = 86%), chronic kidney disease (CKD) (RR: 1.26; 95%CI: 1.10 – 1.45; I² = 3%), as well as procedural characteristics such as self-expandable valve implantation (RR: 1.41; 95%CI: 1.32 – 1.51; I² = 0%). In contrast, no significant risk increase was observed in atrial fibrillation (RR: 1.11; 95%CI: 0.87–1.42; I² = 87%), pre-dilatation (RR: 1.08; 95%CI: 0.81 –1.42; I² = 44%), transapical approach (RR: 0.95; 95%CI: 0.66 – 1.38; I² = 46%), or valve in valve procedures (RR: 1.17; 95%CI: 0.73 – 1.85; I² = 50%) Conclusions This meta-analysis identifies key risk factors for stroke following TAVI, including prior CVE, PAD, CKD, and self-expandable valve implantation. Predicting stroke risk could enhance patient selection and lead to better clinical outcomes.outcomes 1 outcomes 2
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Theodoropoulou et al. (2025) studied this question. Prior cerebrovascular events (RR 1.52), peripheral artery disease (RR 1.34), chronic kidney disease (RR 1.26), and self-expandable valve use (RR 1.41) increase stroke risk post-TAVI.
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