Embolic Stroke Anatomic Distribution Patterns in Patients After TAVR
Eduardo Tellez-Garcia, Bistees George, Joel Corvera, Lola Chabtini, Eric Shin, Michelle Morris, Sara Pereira, Anjan Sinha, Rolf P. KreutzBackground
Ischemic stroke is a feared complication of transcatheter aortic valve replacement (TAVR), yet reported rates remain low (∼1–5%) and are largely derived from clinically apparent events. Whether symptom‐driven detection accurately reflects the true burden and distribution of post‐TAVR stroke remains uncertain.
Methods
We retrospectively analyzed all patients who underwent TAVR within the Indiana University Health system between 2015 and 2025. Patients with clinically documented ischemic stroke were identified through chart review and neuroimaging reports. Stroke patterns were classified as anterior circulation, posterior circulation, or multiterritory based on imaging findings.
Results
Among 2153 TAVR procedures, 31 patients (1.4%) experienced a clinically documented ischemic stroke. Mean age was 78.7 ± 6.8 years, and patients exhibited a high prevalence of vascular risk factors. Posterior circulation‐only stroke occurred in 13 patients (41.9%), multiterritory stroke in 11 (35.5%), and anterior circulation‐only stroke in 7 (22.6%). The median time from TAVR to clinically detected ischemic stroke was 1 day (IQR, 1–2 days), with 22 events (71.0%) occurring on postprocedural days 0–1. Cerebral embolic protection was used in 2 of 31 patients (6.5%).
Conclusions
Clinically detected ischemic stroke occurred in 1.4% of TAVR procedures and most frequently involved posterior circulation‐only or multiterritory patterns. These findings suggest that symptom‐driven detection may not fully reflect the burden or territorial distribution of cerebral ischemic injury following TAVR.