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Abstract Details

The Growing Challenge of Post-TAVR Strokes
Cerebrovascular Disease and Interventional Neurology
P6 - Poster Session 6 (12:00 PM-1:00 PM)
4-010
Transcatheter aortic valve replacement (TAVR) is an increasingly used approach for aortic valve replacement; in 2017, there were 47,779 TAVRs, and 41,490 surgical aortic valve replacements in the US.  Given recent evidence that TAVR may be a safer approach even in low-risk patients, the incidence of post-TAVR strokes is expected to grow. With an expected rate of 1.2% strokes at one year post-TAVR, we expect the number of TAVR-related stroke to be 573 or higher. We present a patient with a calcified cerebral embolus (CCE) after a TAVR procedure. There are no practice parameters or guidelines for optimal treatment for acute CCEs, but we review the literature to inform management of these rare strokes.
To assess the current treatments for post-TAVR strokes.
Literature review was performed via comprehensive search on PubMed, reviewing articles from 2000 to 2019. Keywords used included “calcified,” “embolic,” and “stroke.” The full text of each relevant article was reviewed. 

Literature review and inclusion of our case yielded 25 patients with intervention and mRS at 90 days. Six patients received t-PA only, with an average mRS of 4.75. Thirteen patients had IA only, with an average mRS of 4.1. Six patients had t-PA and IA, with an average mRS of 2. While management of the patient in the above case deferred t-PA given unlikelihood of this to dissolve a CCE, there is some thought that activation of fibrinolysis can help soften any thrombus forming around the calcification and increase mechanical retrievability.

There is limited literature on thrombolysis and/or interventional therapy for post-TAVR calcific emboli. Further study is needed to develop optimal treatment strategies for cerebral calcified emboli, especially given an expected increase in the number of TAVR procedures.

Authors/Disclosures
Kenneth Han (NYU Langone)
PRESENTER
No disclosure on file
Prachi Mehndiratta, MD Dr. Mehndiratta has nothing to disclose.
Michael Phipps, MD, MHS, FAAN (University of Maryland School of Medicine) Dr. Phipps has nothing to disclose.
Seemant Chaturvedi, MD, FAHA, FAAN (University of Maryland) Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra Zeneca. Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Calgary. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Ramar & Paradiso. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Cole, Scott, Kissane. The institution of Dr. Chaturvedi has received research support from NINDS.