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INTRAVENOUS THROMBOLYSIS AND MECHANICAL THROMBECTOMY IN PATIENTS WITH ISCHEMIC STROKE AFTER TAVI

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ESOC-2019

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Abstract

Background and Aims Transcatheter Aortic Valve Implantation (TAVI) is an increasingly treatment modality for severe aortic stenosis, which is associated with a considerable peri-procedural risk of stroke. To date, the clinical safety and efficacy of intravenous recombinant tissue Plasminogen Activator (tPA) and thrombectomy in stroke post-TAVI is not established. We describe a case-series of 12 patients from the Imperial College TAVI Registry. Methods TAVI periprocedural stroke was defined according to the consensus criteria. Using our prospective case series from January 2008 to December 2016, we described the demographics, imaging features and clinical management of twelve patients presenting with stroke after TAVI. Results Our prospective series included 349 patients, 12 (3.50%) patients suffered a stroke (Table 1). One patient received tPA therapy while two patients were treated with thrombectomy (Figure 1). Conclusions This case series emphasizes the importance of early recognition and management of stroke symptoms after a TAVI procedure. Patients should be managed in a hyperacute stroke centre (HASU) with access to thrombolysis and thrombectomy. The use of tPA in patients with acute stroke after TAVI should be considered on a case by case basis only and mechanical thrombectomy should be the standard of care in the presence of large vessel occlusion (Figure 2).

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© Copyright 2020 Morressier GmbH.
All rights reserved.