Incidence and predictors for symptomatic stroke within 30 days after transcatheter aortic valve implantation: insights from the LAPLACE-TAVI registry

Abstract

Background: Stroke is a devastating complication after transcatheter aortic valve implantation (TAVI), however contemporary data on its incidence and predictors remain limited.

Methods and results: We analyzed 4774 consecutive patients undergoing TAVI between April 2010 and June 2024 in the prospective multicenter LAPLACE-TAVI registry. Patients with valve-in-valve procedures, investigational devices, or missing data were excluded. The primary endpoint was symptomatic stroke within 30 days after TAVI. Patients were stratified into 2 groups: Stroke (n = 68) and non-Stroke groups (n = 4706). Baseline characteristics, TAVI procedural data, and clinical outcomes were compared. Multivariate logistic regression was performed to identify predictors of periprocedural stroke. Thirty-day symptomatic stroke occurred in 1.4% of study patients. Stroke patients more frequently had previous stroke, peripheral artery disease (PAD), frailty, and higher Society of Thoracic Surgeons (STS) scores. Nearly 90% of stroke events occurred within 5 days after TAVI. Use of self-expanding (SE) valves was more common in the Stroke group (47% vs. 32%). On multivariate analysis, PAD [odds ratio (OR): 1.70, 95% confidence interval (CI): 1.10-2.63], higher STS score (OR: 1.03, 95%CI: 1.00-1.05), and SE valve use (OR: 1.71, 95%CI: 1.16-2.53) were independent predictors.

Conclusions: In this large multicenter registry, the 30-day incidence of symptomatic stroke after TAVI was 1.4%. PAD, higher STS score, and SE valve use were independent predictors. Careful patient selection and procedural planning are warranted.

Keywords: Predictor; Stroke; Transcatheter aortic valve implantation.