Mechanical Thrombectomy for Transcatheter Aortic Valve Insertion (TAVI)-Related Periprocedural Stroke: Current Literature and Future Directions

Abstract

Transcatheter aortic valve implantation (TAVI) has dramatically altered the treatment of high-risk patients with symptomatic, severe aortic stenosis. Its utilisation has also begun to extend into intermediate- and low-surgical risk patients. Despite major advancements in the field of TAVI, stroke remains a significant complication because of its high mortality and  morbidity rate . This article reviews the role of mechanical thrombectomy (MT) in the management of TAVI-related periprocedural stroke. A comprehensive literature search was performed for studies to include in this systematic review of MT in periprocedural and post-TAVI stroke patients. The search identified 11 case reports in which MT was utilised to treat periprocedural stroke successfully. MT without thrombolysis has several potential benefits for TAVI-related periprocedural stroke because a large proportion of strokes are secondary to nonthrombotic emboli and there is a high bleeding risk associated with patients undergoing TAVI. The authors propose that centres undertaking TAVI procedures have dedicated thrombolysis and thrombectomy pathways for patients who experience a TAVI-related periprocedural stroke.