CoreValve Investigators Analyze Studies for Predictors of Neurological Events

September 13, 2016—Neal S. Kleiman, MD, et al conducted an analysis of neurological events after transcatheter aortic valve replacement (TAVR) and their predictors in the CoreValve studies. The findings are available online ahead of print in Circulation: Cardiovascular Interventions.

The investigators concluded that predictors of early stroke after TAVR included clinical and procedural factors; predictors of later stroke were limited to patient but not anatomic characteristics. They advised that these findings indicate that further refinement of imaging to identify anatomic factors predisposing to embolization may help improve stroke prediction in patients undergoing TAVR.

The investigators noted that the background of the study is that the risk for stroke after TAVR is an important concern. Identification of predictors for stroke is likely to be a critical factor aiding patient selection and management as TAVR use becomes widespread.

As summarized in Circulation: Cardiovascular Interventions, the analysis included patients enrolled in the CoreValve US Extreme Risk and High Risk Pivotal Trials or Continued Access Study who were treated with the self-expanding CoreValve bioprosthesis (Medtronic plc). 

The 1-year stroke rate after TAVR was 8.4%. Analysis of the stroke hazard rate identified an early phase (0–10 days; 4.1% of strokes) and a late phase (11–365 days; 4.3% of strokes). 

The investigators reported that baseline predictors of early stroke included National Institutes of Health Stroke Scale score > 0, previous stroke, previous transient ischemic attack, peripheral vascular disease, absence of previous coronary artery bypass surgery, angina, low body mass index (< 21 kg/m²), and falls within the past 6 months. 

Significant procedural predictors were total time in the catheterization laboratory or operating room, delivery catheter in the body time, rapid pacing used during valvuloplasty, and repositioning of the prosthesis. 

Predictors of stroke between 11 and 365 days were small body surface area, severe aortic calcification, and falls within the past 6 months. There were no significant imaging predictors of early or late stroke, reported the investigators in Circulation: Cardiovascular Interventions.