{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T03:26:44Z","timestamp":1792121204932,"version":"4.4.0"},"reference-count":93,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:p>Cerebrovascular events (CVEs) are a dreaded complication of transcatheter aortic valve replacement (TAVR). They are associated with significant mortality, morbidity, and reduced quality of life and impose a significant burden to health care systems. Although the rates of clinical stroke have reduced since the advent of TAVR, it remains an important complication, particularly as TAVR is increasingly utilized. CVE may occur at the time of the TAVR, as a direct consequence of the procedure, or may occur later, related to thrombosis of the prosthetic valve, atrial fibrillation, and other comorbidities. Imaging of the brain has revealed a high prevalence of subclinical cerebral infarcts (68%\u201398%) associated with the TAVR procedure. Although their clinical significance has not been fully established, clinically evident CVE ranges between 3% and 5% in patients considered at high operative risk to between 1% and 3% in low operative risk patients. Periprocedural CVEs are largely the result of embolization of the thrombus and tissue derived from the valve, vasculature, or myocardium. Cerebral embolic protection devices have been studied in multiple trials, with some evidence supporting a reduction in new cerebral lesion volume, number, and potentially disabling strokes. However, thus far, there is no robust evidence that they reduce the overall stroke rate. The number and severity of comorbidities, in particular, new-onset atrial fibrillation, are associated with CVEs. Valve thrombosis diagnosed using computed tomography as areas of hypoattenuated leaflet thickening has been identified in 10% to 15% of patients. This is a dynamic process associated with an increase in CVEs, but that resolves with anticoagulation or sometimes without it. Routine use of anticoagulation compared with a single antiplatelet agent is associated with an increased risk of bleeding, without any additional alleviation in risk of thromboembolism.<\/jats:p>\n                  <jats:p>Future studies to improve risk stratification could facilitate the tailoring of preventive therapies to patients at high risk of CVE, who stand to gain the most benefit.<\/jats:p>","DOI":"10.1161\/strokeaha.124.047149","type":"journal-article","created":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T05:00:32Z","timestamp":1728277232000},"page":"2754-2764","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Replacement: A Review"],"prefix":"10.1161","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3433-8128","authenticated-orcid":true,"given":"Kush P.","family":"Patel","sequence":"first","affiliation":[{"name":"Institute of Cardiovascular Science, University College London, UK (K.P.P.)."},{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital, London, UK (K.P.P., K.S.R., A.M., A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4268-5055","authenticated-orcid":true,"given":"Krishnaraj S.","family":"Rathod","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital, London, UK (K.P.P., K.S.R., A.M., A.B.)."},{"name":"Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK (K.S.R., A.M., A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8002-7497","authenticated-orcid":true,"given":"Alexandra J.","family":"Lansky","sequence":"additional","affiliation":[{"name":"Yale University School of Medicine, New Haven, CT (A.J.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Prendergast","sequence":"additional","affiliation":[{"name":"Cleveland Clinic London, UK (B.P., A.B.)."},{"name":"St Thomas\u2019 Hospital, London, UK (B.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5356-2395","authenticated-orcid":true,"given":"Rajesh K.","family":"Kharbanda","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK (R.K.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7941-9653","authenticated-orcid":true,"given":"Anthony","family":"Mathur","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital, London, UK (K.P.P., K.S.R., A.M., A.B.)."},{"name":"Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK (K.S.R., A.M., A.B.)."},{"name":"National Institute of Health and Care Research (NINR) Barts Biomedical Research Centre, Queen Mary University of London, UK (A.M., A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4536-9018","authenticated-orcid":true,"given":"Richard","family":"Perry","sequence":"additional","affiliation":[{"name":"University College London, Queen Square Institute of Neurology and the National Hospital for Neurology &amp; Neurosurgery, UK (R.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7707-2254","authenticated-orcid":true,"given":"Andreas","family":"Baumbach","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital, London, UK (K.P.P., K.S.R., A.M., A.B.)."},{"name":"Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK (K.S.R., A.M., A.B.)."},{"name":"Cleveland Clinic London, UK (B.P., A.B.)."},{"name":"National Institute of Health and Care Research (NINR) Barts Biomedical Research Centre, Queen Mary University of London, UK (A.M., A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.05.066"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rec.2022.05.006"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1816885"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1814052"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.03.014"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1103510"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1400590"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1700456"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1514616"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.115.002981"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1008232"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1700456"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.07.036"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.12.026"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.855866"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2010.09.008"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv191"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.10302"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.114.001913"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/suaa007"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.057145"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.110981"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.4244\/EIJV8I1A20"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2016.07.011"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.118.007546"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2023.107054"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.005296"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.111.000034"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2014.04.019"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.10.023"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.05.074"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa022066"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.114.001395"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ-D-21-00951"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000240506.34616.10"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1735323"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2015.01.020"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.4244\/EIJV12I4A84"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1177\/00033197241239687"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2018.05.042"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.092544"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2204961"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.05.065"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.01.055"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2023.02.039"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2023.10.021"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2009.07.031"},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.12.014"},{"key":"e_1_3_2_50_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.907402"},{"key":"e_1_3_2_51_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13019-016-0552-6"},{"key":"e_1_3_2_52_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2022.08.057"},{"key":"e_1_3_2_53_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.02.540"},{"key":"e_1_3_2_54_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.115.003551"},{"key":"e_1_3_2_55_2","doi-asserted-by":"publisher","DOI":"10.4244\/EIJY15M11_12"},{"key":"e_1_3_2_56_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2018.12.041"},{"key":"e_1_3_2_57_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2017.02.098"},{"key":"e_1_3_2_58_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcct.2018.04.007"},{"key":"e_1_3_2_59_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.12.062"},{"key":"e_1_3_2_60_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2018.06.895"},{"key":"e_1_3_2_61_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1600179"},{"key":"e_1_3_2_62_2","doi-asserted-by":"publisher","DOI":"10.1080\/24748706.2020.1805534"},{"key":"e_1_3_2_63_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.04.043"},{"key":"e_1_3_2_64_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.118.007349"},{"key":"e_1_3_2_65_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.026334"},{"key":"e_1_3_2_66_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.121.011480"},{"key":"e_1_3_2_67_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2022.04.018"},{"key":"e_1_3_2_68_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1911425"},{"key":"e_1_3_2_69_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2016.11.005"},{"key":"e_1_3_2_70_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezw407"},{"key":"e_1_3_2_71_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2017.01.045"},{"key":"e_1_3_2_72_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.12.056"},{"key":"e_1_3_2_73_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.03.119"},{"key":"e_1_3_2_74_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2021.06.467"},{"key":"e_1_3_2_75_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2023-323359"},{"key":"e_1_3_2_76_2","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/S0735-1097(22)01619-9","article-title":"Clinical predictors of embolic burden after TAVR: an analysis of the SAFEPASS 2 clinical study.","volume":"79","author":"Lansky AJ","year":"2022","unstructured":"Lansky AJ, White J, Stewart JT, Blake JWH, Smyth D, Pasupati S, Nair R, Parise H, Pietras C, Webster MWI, et al. Clinical predictors of embolic burden after TAVR: an analysis of the SAFEPASS 2 clinical study. J Am Coll Cardiol. 2022;79:628.","journal-title":"J Am Coll Cardiol"},{"key":"e_1_3_2_77_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2017815"},{"key":"e_1_3_2_78_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2017.04.014"},{"key":"e_1_3_2_79_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2014.04.170"},{"key":"e_1_3_2_80_2","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ-D-17-00198"},{"key":"e_1_3_2_81_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2018.04.006"},{"key":"e_1_3_2_82_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2018.10.005"},{"key":"e_1_3_2_83_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2021.05.047"},{"key":"e_1_3_2_84_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.122.059512"},{"key":"e_1_3_2_85_2","unstructured":"TCT. Oral anticoagulation after TAVR doesn\u2019t reduce ischemic cerebral lesions: AUREA. 2019."},{"key":"e_1_3_2_86_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac242"},{"key":"e_1_3_2_87_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2111016"},{"key":"e_1_3_2_88_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1915152"},{"key":"e_1_3_2_89_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.06.035"},{"key":"e_1_3_2_90_2","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2016-218787"},{"key":"e_1_3_2_91_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-020-04344-2"},{"key":"e_1_3_2_92_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.032376"},{"key":"e_1_3_2_93_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2022.06.033"},{"key":"e_1_3_2_94_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.028182"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.124.047149","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T10:54:02Z","timestamp":1748516042000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.124.047149"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11]]},"references-count":93,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1161\/STROKEAHA.124.047149"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.124.047149","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11]]},"assertion":[{"value":"2024-10-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}