Abstract Details

Data were retrospectively abstracted for patients with an AIS after TAVR within a large regional healthcare system. Baseline demographics and post AIS outcomes were analyzed using Fisher’s exact tests and unpaired T-tests.

From 2011-2023, 2342 patients underwent TAVR, of which 44 (1.9%) had peri-procedural AIS. There were 9 tPA, 5 TNK and 30 non-thrombolytics cases. There was no difference in baseline characteristics. During index hospitalization, thrombolytics use was associated with more groin bleeding (10 {71%} thrombolytics vs. 7 {23%} non-thrombolytics p=0.006) and drops in hemoglobin >2 g/dL(9 {64%} thrombolytics vs. 9 {30%} non-thrombolytics p=0.049). There were no differences in cardiac outcomes (Atrial fibrillation, myocardial infarction, or new congestive heart failure at 90 days), symptomatic ICH, 90 day mRS, or death at 90 days with IV thrombolytics as a whole. However, all deaths in the thrombolytics group occurred in TNK patients (3 {60%} deaths with TNK vs. 3 {10%} deaths with non-thrombolytics p=0.044).

This is one of the largest case series on patients who had AIS after TAVR and received thrombolytics. There was no difference between adverse neurological or cardiac outcomes at discharge in the thrombolytics group vs. non-thrombolytics group. More thrombolytics patients had symptomatic bleeding. There was a signal for increased death in the TNK subgroup, but its interpretation is limited by its small sample size (n=5). Overall, tPA appears to be a safe intervention for AIS after TAVR.