While the rate of stroke has decreased since the early days of transcatheter aortic valve replacement (TAVR), it remains non-negligible, reaching up to 1%-3% at 30 days. As TAVR progressively expands to low-risk populations and younger patients, identifying risk factors for patient selection and management in stroke prevention becomes crucial. While researchers have identified predictors...
AHA 2023 | Use of Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation
Subclinical atrial fibrillation (AF), generally asymptomatic and of short duration, often requires continuous long-term monitoring using pacemakers or defibrillators for its detection. While subclinical AF is linked to an increased risk of stroke, the usefulness of oral anticoagulation as a treatment remains uncertain. In a double-blind randomized trial, one group received apixaban and the other...
OBSERVANT II: Post TAVR 30-Day and 6-Month Stroke Predictors
Despite stroke rate has declined since the early days of transcatheter aortic valve replacement (TAVR), it remains significant, reaching 1% to 3% 30 days after procedure. Since TAVR has seen a progressive expansion to the low risk and young populations, identifying risk factors in patient selection and management is crucial for us to prevent stroke. ...
Should We Treat Stroke Percutaneously in TAVR?
Since its inception, transcatheter aortic valve replacement (TAVR) has improved greatly. However, there still are five big challenges to be solved: paravalvular leak, conduction disturbances, debilitating stroke, impaired kidney function, and major vascular complications and bleeding. Most cases of stroke are periprocedural and ischemic. So far, they have not been well analyzed in terms of...
Complicated Non-Stenotic Carotid Plaques: A Light in the Diagnosis of Cryptogenic Stroke?
Stroke is one of the leading causes of death and disability. It produces great morbidity by causing marked post-event cognitive impairment. Recurrence of an ischemic event may vary according to the cause of the stroke. Complicated non-stenotic carotid plaque (CCP) type VI (according to the American Heart Association [AHA] classification) has been described as an...
EuroPCR 2022 | ASTRO TAVR: Should we treat post TAVR Strokes with Neurointervention?
The presence of stroke after TAVR has dropped and is currently at 2%; however, it is 5 times more deadly, has negatively affected quality of life and has increased healthcare costs. The ASTRO TAVI registry included 14 centers and 16615 TAVR procedures between 2006 y 2021. In this period, there were 484 neurological events within...
Can Ticagrelor Prevent Strokes in High-Risk Patients?
In addition to aspirin, Ticagrelor offers better prognosis in patients that already had a stroke and have a high-risk cardiovascular profile. These benefits should be correctly balanced seeing as they are not free of risk. Antiplatelet therapy makes part of the standard treatment of cardiac or cerebrovascular patients. Ticagrelor has shown superior to clopidogrel in...
Can We Deal with Learning Curves in Acute Stroke?
When an interventional cardiology center, where interventional cardiology specialists work alongside neurologists and radiologists, start a thrombectomy program in acute stroke, results achieved are similar to those at an interventional neurology center. Mechanical thrombectomy has proven to be the best treatment option for acute ischemic stroke. However, it is not widely available, mainly due to...
The Key to Treating Stroke: Knowing When to Stop
With endovascular therapy as the standard of care in ischemic stroke and with a community of interventional cardiologists increasingly committed to assisting neurologists in providing 24/7 thrombectomy, staying informed is paramount. The number of thrombectomy attempts with retractable stent (>3) is associated with hemorrhagic transformation beyond age, baseline NIHSS (National Institutes of Health Stroke Scale)...
Single or Dual Antiplatelet Therapy in Stroke or Transient Ischemic Attack?
Antiplatelet therapy is key to prevent thrombotic events after a transient ischemic attack (TIA) or ischemic stroke. The role of aspirin is well established in this scenario, but there is emerging evidence for a short period of dual antiplatelet therapy (DAPT). Now, can this strategy avoid recurrent strokes without paying a price in terms of...