Key result
Neurological complications including early stroke and silent brain infarctions remain significant challenges following TAVI, and routine use of cerebral embolic protection has not been shown to significantly reduce overall stroke incidence.
Why the study?
Neurological complications including stroke and silent brain infarctions remain significant challenges following TAVI, with unclear prevention strategies and impact on cognitive function.
Cerebrovascular events remain a critical complication of TAVI that offset cardiovascular benefits, requiring individualized antithrombotic strategies (favoring single antiplatelet therapy for those without oral anticoagulation indications) while the role of cerebral embolic protection requires further clarification.
Cautions against routine cerebral embolic protection in TAVI; leaves open development of effective strategies to mitigate early stroke and silent infarctions.
Introduction. TAVI is an established treatment for severe aortic stenosis in older patients at high peri-operative risk. However, this procedure is still associated with serious cerebrovascular complications. This review aims to synthesize current evidence on the risk factors, incidence, prognostic implications, impact on cognitive function, and strategies for preventing cerebrovascular events, including stroke and SBIs, following TAVI. Material and methods. Articles were selected through searches of PubMed, Google Scholar, and ScienceDirect, primarily covering publications from 2010 to 2026. Results. The findings indicate that stroke risk is highest within the first 48 hours after the procedure, predominantly due to embolism. Stroke markedly increases 30-day mortality and is associated with disability. SBIs, detected in over 70% of patients, may be associated with early cognitive decline, although their long-term impact requires further study. CEP has not been shown to significantly reduce the incidence of TAVI-related stroke. Further studies are needed to clarify the role of CEP in periprocedural stroke prevention. Regarding pharmacotherapy, SAPT is the preferred strategy for patients without indications for OAC, whereas patients with pre-existing indications for OAC should receive OAC. Conclusions. Neurological complications remain a significant clinical challenge that can offset the cardiovascular benefits of TAVI. Improving outcomes requires an individualized approach to pharmacotherapy and further clarification of the role of CEP.
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Poland et al. (2026) conducted a review in Severe aortic stenosis. Transcatheter aortic valve implantation (TAVI) was evaluated. Neurological complications including early stroke and silent brain infarctions remain significant challenges following TAVI, and routine use of cerebral embolic protection has not been shown to significantly reduce overall stroke incidence.
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