Impact of Very Severe Aortic Stenosis on Periprocedural Stroke Risk After Transcatheter Aortic Valve Replacement

초록

BACKGROUND Transcatheter aortic valve replacement (TAVR) is the standard treatment for severe aortic stenosis (SAS); however, TAVR-related stroke remains a significant concern. Although cerebral embolic protection (CEP) has been explored, identifying high-risk patients remains challenging. Very severe AS (VSAS), defined as a peak aortic velocity of 25 m/s, represents an advanced disease stage. However, its association with stroke risk after TAVR has not been well studied. This study aimed to assess the impact of VSAS on periprocedural stroke risk and evaluate the potential protective role of CEP. METHODS We conducted a prospective analysis of 241 patients who underwent TAVR at a single center between 2020 and 2025. Patients were categorized into SAS (n = 204) and VSAS (n = 37) groups. The primary endpoint was the incidence of TAVR-related stroke, while secondary outcomes included procedural success, complications, and 1-year clinical outcomes. Multivariate analysis identified independent predictors of stroke. RESULTS Stroke incidence was significantly higher in the VSAS group than in the SAS group (13.5% vs. 4.4%, p = 0.046). VSAS was identified as an independent predictor of stroke (adjusted hazard ratio: 4.46; 95% CI, 1.32–15.05, p = 0.016). While CEP demonstrated a trend toward reducing disabling strokes in patients with VSAS, the difference was not statistically significant. One-year composite outcomes were more favorable in the VSAS group than in the SAS group (2.7% vs. 15.2%, log-rank p = 0.041). CONCLUSION VSAS is a strong independent risk factor for TAVR-related stroke. Given the improved long-term outcomes in patients with VSAS, further exploration of stroke mitigation strategies, such as CEP, is warranted to optimize clinical outcomes.