When brain and heart collide: a deeper dive into treatment pathways of stroke complicating TAVI

Periprocedural ischemic stroke remains a major concern of transcatheter aortic valve implantation (TAVI). The aims of this study were to describe the incidence, characteristic, and outcomes of patients presenting with acute ischemic stroke complicating TAVI (AISCT), and to compare conservative management (CM) vs. neurointervention (NI), in eligible patients. We analyzed consecutive TAVI procedures performed in the Rabin Medical Center between 2008 and 2021. The patients with and without AISCT were compared. Outcomes of NI following AISCT were compared to CM. The primary outcomes were mortality at 1 and 3 years and neurologic disability status at 3 months. Of 1515 eligible patients who underwent TAVI between 2008 and 2021, 38 (2.5%) had AISCT within 30 days. All-cause mortality was significantly higher in the AISCT group in 30 days (13.9% vs. 2.4%, p < 0.01), 1 year (27.8% vs. 8.1%, p < 0.01), and 3 years (49.0% vs. 26.8%, p < 0.01), as compared to the AISCT negative group. Out of the 38 patients who suffered AISCT between 2008 and 2021, 7 underwent NI. The majority of AISCT were observed within the first 24-h following TAVI (p < 0.01). All-cause mortality following moderate/severe stroke was significantly higher (p = 0.037) compared to mild stroke. As compared to the CM, NI was not found to reduce mortality. However, patients with moderate severity stroke who underwent NI enjoyed a higher rate of disability free survival at 3 months (100% vs. 40%, p = 0.044), compared to patients treated conservatively. NI, as compared to CM, may improve disability status in eligible patients with moderate stroke.