Use of the Acurate Neo TAVI device was associated with a 2.9-fold higher risk of non-procedural stroke post-TAVI, especially in patients with higher valve calcification.
What is the incidence of stroke after TAVI and what factors, including device type, are associated with this complication?
Post-TAVI stroke remains a significant complication (7.2% incidence), with male sex and the use of the Acurate Neo device identified as independent risk factors for non-procedural stroke.
Absolute Event Rate: 0% vs 0%
Abstract Background Transcatheter aortic valve implantation (TAVI) has emerged as the first-line treatment for patients with aortic stenosis. Despite the development of new-generation TAVI devices, ischemic stroke remains one of the major complications of the procedure. Purpose The aim of our study was to analyze the incidence of stroke after TAVI implantation and identify the variables associated with this complication, including the type of TAVI device used. Methods We conducted a retrospective study of 652 patients who underwent TAVI implantation at our center between 2013 and 2024. A stroke-free survival analysis was performed with a median follow-up of 40 months. Stroke after TAVI was classified according to the time of occurrence into four groups: periprocedural acute (24 hours), periprocedural subacute (1–30 days), early (30 days–1 year), and late (1 year), following the Valve Academic Research Consortium 3 (VARC-3) criteria. The stroke rate was compared among the Edwards Sapien, Portico/Navitor, and Acurate Neo TAVI devices, and a Cox regression model was used to identify factors associated with post-TAVI stroke. Results The mean age was 80.5±5.4 years, and 55.4% were women. A history of stroke was present in 73 patients (11.2%). During follow-up, 47 patients (7.2%) experienced a stroke: periprocedural acute in 13 patients (2%), subacute in 2 patients (0.3%), early in 2 patients (0.3%), and late in 8 patients (1.2%). The distribution of baseline variables and stroke incidence during follow-up, depending on the type of TAVI device, is shown in the table. In the multivariate survival analysis using the Cox regression model, male sex (HR: 2.1; 95% CI: 1.2 to 3.9; p=0.011) and the use of the Acurate Neo TAVI device (HR: 2.9; 95% CI: 1.3 to 6.2; p=0.007) were the only factors associated with non-procedural stroke during follow-up. Among patients treated with Acurate Neo, valve calcification (Agatston score) was significantly higher in those who developed stroke after the procedure (1029.3 vs. 664.4; p = 0.036). This finding, along with the low rate of post-dilation, suggests that device underexpansion may be related to the higher stroke rate observed with this prosthesis. Conclusions Post-TAVI stroke remains a significant complication, with variations in incidence depending on the prosthesis model. Appropriate device selection and implantation techniques aimed at preventing underexpansion may help reduce the post-TAVI stroke rate.Table.Distribution of baseline variables Graphic.Kaplan Meier survival analysis
Feu et al. (Sat,) reported a other. Use of the Acurate Neo TAVI device was associated with a 2.9-fold higher risk of non-procedural stroke post-TAVI, especially in patients with higher valve calcification.