TY - JOUR
T1 - A systematic review and meta-analysis of the cerebrovascular event incidence after transcatheter aortic valve implantation
AU - Meertens, M.M.
AU - Macherey, S.
AU - Asselberghs, S.
AU - Lee, S.
AU - Schipper, J.H.
AU - Mees, B.
AU - Eitel, I.
AU - Baldus, S.
AU - Frerker, C.
AU - Schmidt, T.
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
PY - 2022/8
Y1 - 2022/8
N2 - Objective Periinterventional stroke is one of the most feared potential complication, among patients treated with transcatheter aortic valve implantation (TAVI). The purpose of this review was to investigate the incidence of cerebrovascular events and the influence of postinterventional neurologic check-up in patients undergoing TAVI.Methods A systematic review and meta-analysis were conducted according to the PRISMA guideline. Three separate electronic searches of the public domains Medline and Clinicaltrials.gov were performed to identify the 30-day incidence of stroke within randomized controlled trials (RCTs) and registries for patients undergoing a TAVI procedure. A meta-analysis was conducted to evaluate the 30-day incidence of stroke within RCTs. Furthermore, we pooled the RCTs in which a scheduled neurological check-up was conducted or not to investigate the effect of this intervention.Results Twenty-three studies including 399,532,491 TAVI patients were included, 6370 from RCTs, 857,833 from cerebral-embolic protection device RCTs and 392,288 were adopted from registries. The mean 30-day incidence of stroke among all reviewed studies was 2.33%. In RCTs evaluating TAVI the pooled stroke incidence was 3.86%, among RCTs focused CEP the incidence was 6.4436% and in registries the incidence was 2.29%. Ten RCTs conducted scheduled neurological check-ups, the incidence in these was 4.03% and among the remaining RCTs it was 2.47%. In the meta-analysis, the pooled 30-day stroke incidence was 3.61% (95% CI 2.57-4.79%).Conclusion This systematic review demonstrates that the stroke incidences following TAVI differ strongly according to the study design and neurological follow-up. Intense neurological testing increases the incidence of a stroke after TAVI.[GRAPHICS].
AB - Objective Periinterventional stroke is one of the most feared potential complication, among patients treated with transcatheter aortic valve implantation (TAVI). The purpose of this review was to investigate the incidence of cerebrovascular events and the influence of postinterventional neurologic check-up in patients undergoing TAVI.Methods A systematic review and meta-analysis were conducted according to the PRISMA guideline. Three separate electronic searches of the public domains Medline and Clinicaltrials.gov were performed to identify the 30-day incidence of stroke within randomized controlled trials (RCTs) and registries for patients undergoing a TAVI procedure. A meta-analysis was conducted to evaluate the 30-day incidence of stroke within RCTs. Furthermore, we pooled the RCTs in which a scheduled neurological check-up was conducted or not to investigate the effect of this intervention.Results Twenty-three studies including 399,532,491 TAVI patients were included, 6370 from RCTs, 857,833 from cerebral-embolic protection device RCTs and 392,288 were adopted from registries. The mean 30-day incidence of stroke among all reviewed studies was 2.33%. In RCTs evaluating TAVI the pooled stroke incidence was 3.86%, among RCTs focused CEP the incidence was 6.4436% and in registries the incidence was 2.29%. Ten RCTs conducted scheduled neurological check-ups, the incidence in these was 4.03% and among the remaining RCTs it was 2.47%. In the meta-analysis, the pooled 30-day stroke incidence was 3.61% (95% CI 2.57-4.79%).Conclusion This systematic review demonstrates that the stroke incidences following TAVI differ strongly according to the study design and neurological follow-up. Intense neurological testing increases the incidence of a stroke after TAVI.[GRAPHICS].
KW - Stroke
KW - Transcatheter aortic valve implantation
KW - Transcatheter aortic valve replacement
KW - Cerebral protection device
KW - Aortic stenosis
KW - CEREBRAL EMBOLIC PROTECTION
KW - RANDOMIZED EVALUATION
KW - RISK PATIENTS
KW - REPLACEMENT
KW - STROKE
KW - COMPLICATIONS
KW - STENOSIS
KW - INSIGHTS
KW - OUTCOMES
KW - QUALITY
U2 - 10.1007/s00392-022-01997-1
DO - 10.1007/s00392-022-01997-1
M3 - (Systematic) Review article
C2 - 35298700
SN - 1861-0684
VL - 111
SP - 843
EP - 858
JO - Clinical research in cardiology
JF - Clinical research in cardiology
IS - 8
ER -