{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T03:26:34Z","timestamp":1792121194626,"version":"4.4.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T00:00:00Z","timestamp":1620172800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T00:00:00Z","timestamp":1620172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Swedish National ALF-funds"},{"name":"Regional research funds regions Sk\u00e5ne"},{"name":"Heart-Lung Foundation"},{"name":"F\u00e4rs och Frosta Sparbank"},{"DOI":"10.13039\/501100003252","name":"Lund University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003252","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Transcatheter aortic valve replacement (TAVR) is a rapidly growing field. Short-term safety and efficacy of these procedures have been studied extensively. However, little is known about the safety of these devices over time. Stroke is one feared long-term complication, and an increased stroke rate could affect guidelines for treating both the aortic stenosis and choosing antithrombotic therapy after TAVR. The primary objective was to study the incidence of stroke up to 8\u00a0years after TAVR implantation, comparing it with the risk of stroke in the general population. Secondary objectives were to study risk factors for late stroke and to study outcomes after stroke. A nationwide, all-comers study of patients who underwent TAVR in Sweden 2008\u20132018 was performed. The study was based on data from three national registries: a TAVR registry, a stroke registry, and a diagnosis registry. The main outcome was stroke incidence 30-days or more after TAVR implantation and was compared to a standardized incidence. The annual risk for stroke varied between 2.0% and 3.1% as compared to 1.5% and 1.9% in an age- and sex-matched cohort. Risk factors for developing stroke were reduced renal function, diabetes, history of stroke, age, and male sex. The 1-year mortality after stroke was 44%. This study demonstrated an increased rate of stroke after TAVR, but the findings suggest that this can in part be attributed to the group\u2019s higher frequency of pre-disposing risk factors.<\/jats:p>","DOI":"10.1038\/s41598-021-89217-0","type":"journal-article","created":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T10:07:04Z","timestamp":1620209224000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Late stroke after transcatheter aortic valve replacement: a nationwide study"],"prefix":"10.1038","volume":"11","author":[{"given":"Henrik","family":"Bjursten","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Norrving","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigurdur","family":"Ragnarsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,5,5]]},"reference":[{"issue":"18","key":"89217_CR1","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.1056\/NEJMoa1814052","volume":"380","author":"MJ Mack","year":"2019","unstructured":"Mack, M. J. et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N. Engl. J. Med. 380(18), 1695\u20131705 (2019).","journal-title":"N. Engl. J. Med."},{"issue":"17","key":"89217_CR2","doi-asserted-by":"publisher","first-page":"1609","DOI":"10.1056\/NEJMoa1514616","volume":"374","author":"MB Leon","year":"2016","unstructured":"Leon, M. B. et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N. Engl. J. Med. 374(17), 1609\u20131620 (2016).","journal-title":"N. Engl. J. Med."},{"issue":"9986","key":"89217_CR3","doi-asserted-by":"publisher","first-page":"2477","DOI":"10.1016\/S0140-6736(15)60308-7","volume":"385","author":"MJ Mack","year":"2015","unstructured":"Mack, M. J. et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): A randomised controlled trial. Lancet 385(9986), 2477\u20132484 (2015).","journal-title":"Lancet"},{"issue":"18","key":"89217_CR4","doi-asserted-by":"publisher","first-page":"1706","DOI":"10.1056\/NEJMoa1816885","volume":"380","author":"JJ Popma","year":"2019","unstructured":"Popma, J. J. et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N. Engl. J. Med. 380(18), 1706\u20131715 (2019).","journal-title":"N. Engl. J. Med."},{"issue":"2","key":"89217_CR5","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.jacc.2015.05.017","volume":"66","author":"MJ Reardon","year":"2015","unstructured":"Reardon, M. J. et al. 2-Year outcomes in patients undergoing surgical or self-expanding transcatheter aortic valve replacement. J. Am. Coll. Cardiol. 66(2), 113\u2013121 (2015).","journal-title":"J. Am. Coll. Cardiol."},{"key":"89217_CR6","unstructured":"UCR. Swedeheart annual report 2019. (Accessed 30 September 2020); https:\/\/www.ucr.uu.se\/swedeheart\/dokument-sh\/arsrapporter-sh."},{"issue":"4","key":"89217_CR7","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/j.jcct.2019.12.001","volume":"14","author":"F Pollari","year":"2020","unstructured":"Pollari, F. et al. Aortic valve calcification as a risk factor for major complications and reduced survival after transcatheter replacement. J. Cardiovasc. Comput. Tomogr. 14(4), 307\u2013313 (2020).","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"issue":"3","key":"89217_CR8","doi-asserted-by":"publisher","first-page":"e007546","DOI":"10.1161\/CIRCINTERVENTIONS.118.007546","volume":"12","author":"W Vlastra","year":"2019","unstructured":"Vlastra, W. et al. predictors, incidence, and outcomes of patients undergoing transfemoral transcatheter aortic valve implantation complicated by stroke. Circ. Cardiovasc. Interv. 12(3), e007546 (2019).","journal-title":"Circ. Cardiovasc. Interv."},{"issue":"9","key":"89217_CR9","doi-asserted-by":"publisher","first-page":"e003551","DOI":"10.1161\/CIRCINTERVENTIONS.115.003551","volume":"9","author":"NS Kleiman","year":"2016","unstructured":"Kleiman, N. S. et al. Neurological events following transcatheter aortic valve replacement and their predictors: A report from the CoreValve trials. Circ. Cardiovasc. Interv. 9(9), e003551 (2016).","journal-title":"Circ. Cardiovasc. Interv."},{"issue":"23","key":"89217_CR10","doi-asserted-by":"publisher","first-page":"2306","DOI":"10.1001\/jama.2019.7525","volume":"321","author":"CP Huded","year":"2019","unstructured":"Huded, C. P. et al. Association between transcatheter aortic valve replacement and early postprocedural stroke. JAMA 321(23), 2306\u20132315 (2019).","journal-title":"JAMA"},{"issue":"14","key":"89217_CR11","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.1056\/NEJMoa1700456","volume":"376","author":"MJ Reardon","year":"2017","unstructured":"Reardon, M. J. et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N. Engl. J. Med. 376(14), 1321\u20131331 (2017).","journal-title":"N. Engl. J. Med."},{"issue":"3","key":"89217_CR12","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/j.jacc.2015.05.025","volume":"66","author":"J Bosmans","year":"2015","unstructured":"Bosmans, J. et al. The incidence and predictors of early- and mid-term clinically relevant neurological events after transcatheter aortic valve replacement in real-world patients. J. Am. Coll. Cardiol. 66(3), 209\u2013217 (2015).","journal-title":"J. Am. Coll. Cardiol."},{"issue":"39","key":"89217_CR13","doi-asserted-by":"publisher","first-page":"3263","DOI":"10.1093\/eurheartj\/ehz588","volume":"40","author":"H Bjursten","year":"2019","unstructured":"Bjursten, H. et al. Infective endocarditis after transcatheter aortic valve implantation: A nationwide study. Eur. Heart J. 40(39), 3263\u20133269 (2019).","journal-title":"Eur. Heart J."},{"issue":"42","key":"89217_CR14","doi-asserted-by":"publisher","first-page":"3777","DOI":"10.1093\/eurheartj\/ehy519","volume":"39","author":"EM Antman","year":"2018","unstructured":"Antman, E. M. Improving care at the population and individual level: Lessons from SWEDEHEART. Eur. Heart J. 39(42), 3777\u20133779 (2018).","journal-title":"Eur. Heart J."},{"key":"89217_CR15","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1186\/1471-2458-11-450","volume":"11","author":"JF Ludvigsson","year":"2011","unstructured":"Ludvigsson, J. F. et al. External review and validation of the Swedish national inpatient register. BMC Public Health 11, 450 (2011).","journal-title":"BMC Public Health"},{"issue":"4","key":"89217_CR16","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1159\/000444679","volume":"46","author":"A Soderholm","year":"2016","unstructured":"Soderholm, A., Stegmayr, B., Glader, E. L., Asplund, K. & Riksstroke, C. Validation of hospital performance measures of acute stroke care quality. Riksstroke, the Swedish Stroke Register. Neuroepidemiology 46(4), 229\u2013234 (2016).","journal-title":"Neuroepidemiology"},{"key":"89217_CR17","unstructured":"SCB, Official Swedish statistical office. (Accessed 30 September 2020); www.statistikdatabasen.scb.se."},{"issue":"5","key":"89217_CR18","doi-asserted-by":"publisher","first-page":"S45","DOI":"10.1093\/ejcts\/ezs533","volume":"42","author":"AP Kappetein","year":"2012","unstructured":"Kappetein, A. P. et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: The Valve Academic Research Consortium-2 consensus document (VARC-2). Eur. J. Cardiothorac. Surg. 42(5), S45-60 (2012).","journal-title":"Eur. J. Cardiothorac. Surg."},{"issue":"1","key":"89217_CR19","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/S1010-7940(99)00134-7","volume":"16","author":"SA Nashef","year":"1999","unstructured":"Nashef, S. A. et al. European system for cardiac operative risk evaluation (EuroSCORE). Eur. J. Cardiothorac. Surg. 16(1), 9\u201313 (1999).","journal-title":"Eur. J. Cardiothorac. Surg."},{"issue":"9","key":"89217_CR20","doi-asserted-by":"publisher","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","volume":"150","author":"AS Levey","year":"2009","unstructured":"Levey, A. S. et al. A new equation to estimate glomerular filtration rate. Ann. Intern. Med. 150(9), 604\u2013612 (2009).","journal-title":"Ann. Intern. Med."},{"issue":"4","key":"89217_CR21","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1159\/000345953","volume":"40","author":"M Koster","year":"2013","unstructured":"Koster, M., Asplund, K., Johansson, A. & Stegmayr, B. Refinement of Swedish administrative registers to monitor stroke events on the national level. Neuroepidemiology 40(4), 240\u2013246 (2013).","journal-title":"Neuroepidemiology"},{"key":"89217_CR22","doi-asserted-by":"publisher","first-page":"53","DOI":"10.2147\/CLEP.S122916","volume":"9","author":"C Johansson","year":"2017","unstructured":"Johansson, C., Dahlqvist, E., Andersson, J., Jansson, J. H. & Johansson, L. Incidence, type of atrial fibrillation and risk factors for stroke: A population-based cohort study. Clin. Epidemiol. 9, 53\u201362 (2017).","journal-title":"Clin. Epidemiol."},{"key":"89217_CR23","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1186\/1471-2458-13-670","volume":"13","author":"AC Carlsson","year":"2013","unstructured":"Carlsson, A. C. et al. High prevalence of diagnosis of diabetes, depression, anxiety, hypertension, asthma and COPD in the total population of Stockholm, Sweden\u2014A challenge for public health. BMC Public Health 13, 670 (2013).","journal-title":"BMC Public Health"},{"issue":"11","key":"89217_CR24","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.1161\/01.STR.19.11.1345","volume":"19","author":"G Boysen","year":"1988","unstructured":"Boysen, G. et al. Stroke incidence and risk factors for stroke in Copenhagen. Denmark. Stroke. 19(11), 1345\u20131353 (1988).","journal-title":"Denmark. Stroke."},{"key":"89217_CR25","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1161\/STROKEAHA.118.022913","volume":"50","author":"S Sennfalt","year":"2019","unstructured":"Sennfalt, S., Norrving, B., Petersson, J. & Ullberg, T. Long-term survival and function after stroke. Stroke 50, 53\u201361 (2019).","journal-title":"Stroke"},{"issue":"7","key":"89217_CR26","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1016\/j.jcin.2019.11.022","volume":"13","author":"G Muntane-Carol","year":"2020","unstructured":"Muntane-Carol, G. et al. Late cerebrovascular events following transcatheter aortic valve replacement. JACC Cardiovasc. Interv. 13(7), 872\u2013881 (2020).","journal-title":"JACC Cardiovasc. Interv."},{"issue":"20","key":"89217_CR27","doi-asserted-by":"publisher","first-page":"1617","DOI":"10.1136\/hrt.2010.198804","volume":"96","author":"T Jernberg","year":"2010","unstructured":"Jernberg, T. et al. The Swedish Web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies (SWEDEHEART). Heart 96(20), 1617\u20131621 (2010).","journal-title":"Heart"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-89217-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-89217-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-89217-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T07:40:03Z","timestamp":1670053203000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-89217-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,5]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["89217"],"URL":"https:\/\/doi.org\/10.1038\/s41598-021-89217-0","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,5]]},"assertion":[{"value":"10 February 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 April 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 May 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"HB has served as a consultant for Boston Scientific and Edwards Lifescience. BN has received fees from Astra Zeneca and Bayer for work in data monitoring committees in the SOCRATES, THALES and NAVIGATE-ESUS trials. SR does not have any relevant conflict of interest to report.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"9593"}}