High risk patent foramen ovale closure PFO resulted in reduced stroke, vascular death and bleeding risk. Recent reports have shown a favorable role of PFO in patients with cryptogenic stroke, though with some unclear results, which immediately raised the questions: Who are the optimal candidates for this procedure, and who will see no benefit? ...
Are the Rates of Stroke Similar in TAVR and Surgery?
Courtesy of Dr. Carlos Fava. Stroke is one of the most undesirable complications we can face and, regarding transcatheter aortic valve replacement (TAVR), major studies presented have rates of stroke of about 4%. In others, rates have been slightly higher. This meta-analysis included 5 randomized studies between 2011 and 2017: PARTNER, CoreVALVE, NOTION, PARTNER 2, and SURTAVI....
What Antiplatelet Therapy Should We Use in Patients with Stroke/TIA? Interesting Results for the POINT Trial
Courtesy of Dr. Alejandro Lakowsky, MTSAC (Full Member of the Argentine Society of Cardiology) The New England Journal of Medicine (NEJM) recently published an article about the POINT trial (simultaneously presented at the European Stroke Organisation Conference), a long-awaited randomized clinical trial to assess the efficacy and safety of dual antiplatelet therapy (DAPT) with aspirin...
EuroPCR 2018 | SENTINEL: Anatomical Predictors of Stroke during TAVR
The rate of cerebrovascular events in TAVR hovers about 4% in most of the current studies, regardless the center, the operator or the prosthetic valve. At present, no scores can adequately predict which patients run the highest risk of stroke during TAVR, and the routine use of cerebral protection devices remains controversial. The SENTINEL study...
Stroke, Migraine and Patent Foramen Ovale Not Necessarily Temporary Associated
Cryptogenic stroke patients with migraine have high prevalence (79%) of patent foramen ovale (PFO) with right to left shunt. However, the timing of stroke in migraineurs is not usually associated to a migraine attack. These observations are consistent with the hypothesis that the most likely mechanism of stroke in these patients with migraine is a...
It Is a Fact: Cerebral Protection in TAVR Has Proved to Reduce Stroke and Death
Cerebral ischemic events after transcatheter aortic valve replacement (TAVR) have been identified as independent predictors of morbidity and mortality. New-generation devices have managed to partially reduce the rate of cerebral events, but it still is around 5.5% at 30 days for patients undergoing TAVR through transfemoral access. First data on cerebral protection devices had only shown...
CLOSE Trial: Patients with PFO with high flow or associated with interatrial septal aneurysm receiving closure device experience lower rates of recurrent stroke
Several cases have shown an association between patent foramen ovale and cryptogenic shock, particularly in patients under 55 and in those with atrial septal aneurysm or a significant right-to-left shunt. Using PFO closure for stroke prevention has been controversial and, so far, no randomized studies have shown the superiority of this strategy compared to anti-thrombotic...
REDUCE Trial: Patients with PFO and cryptogenic stroke at lower risk of recurrent stoke when treated with APT and closure device
Courtesy of Dr. José Álvarez. This is a multicenter randomized study on patients with patent foramen ovale (PFO) and a first episode of cryptogenic stroke. It only included patients with moderate to large shunt based on the number of bubbles observed in the left atrium within the first three beats after being noticed in the...
Protection Systems Reduce Stroke and Mortality in Carotid Artery Stenting
So far, the main controlled randomized studies have almost exclusively been aimed at comparing the efficacy and safety of carotid artery stenting vs. endarterectomy. Almost all of them have left at operator discretion the choice of the devices to be used during the procedure, which is why there is few direct information to help us...
Post-dilation in TAVI associated to more stroke and more paravalvular regurgitation
Courtesy of Dr. Carlos Fava. Moderate/severe paravalvular regurgitation (PVR) after TAVR is present in 10%-14% of all cases, according to different series. The treatment of choice is post-dilation, generally effective in most cases. However, this strategy carries a risk of stroke. The true impact of this conduct is still unclear. This review analyzed 6 studies that included 5007 patients; 889 of...