Podcast 787: TAVR and Stroke

<p><strong>Contributor: Nick Hatch, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Transcatheter aortic valve replacement (TAVR) is an increasingly common endovascular procedure to treat aortic stenosis</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">TAVR is an alternative to the open approach surgical aortic valve replacement (SAVR) for patients who are inoperable or are high risk surgical candidates</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Following TAVR, there is increased risk of stroke, particularly in the first 30 days</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">TAVR-related strokes are due to embolic debris left on the valve root, which is generally cleaned out during SAVR</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Further, following the procedure many patients are anticoagulated which increases the risk for conversion to hemorrhagic stroke</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Isolated, unexplained nausea and vomiting in elderly patients should prompt concern for a neurologic workup with imaging - even more so if they have recently undergone TAVR </span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Davlouros PA, Mplani VC, Koniari I, Tsigkas G, Hahalis G. Transcatheter aortic valve replacement and stroke: a comprehensive review.</span> <em><span style= "font-weight: 400;">J Geriatr Cardiol</span></em><span style= "font-weight: 400;">. 2018;15(1):95-104. doi:10.11909/j.issn.1671-5411.2018.01.008</span></p> <p><span style="font-weight: 400;">Gleason TG, Reardon MJ, Popma JJ, et al. 5-Year Outcomes of Self-Expanding Transcatheter Versus Surgical Aortic Valve Replacement in High-Risk Patients.</span> <em><span style="font-weight: 400;">J Am Coll Ca