Incidence and predictors for symptomatic stroke within 30 days after transcatheter aortic valve implantation: insights from the LAPLACE-TAVI registry

BACKGROUND Stroke is a devastating complication after transcatheter aortic valve implantation (TAVI), however contemporary data on its incidence and predictors remain limited. METHOD AND RESULTS We analyzed 4774 consecutive patients undergoing TAVI between April 2010 and June 2024 in the prospective multicenter LAPLACE-TAVI registry. Patients with valve-in-valve procedures, investigational devices, or missing data were excluded. The primary endpoint was symptomatic stroke within 30 days after TAVI. Patients were stratified into 2 groups: Stroke (n = 68) and non-Stroke groups (n = 4706). Baseline characteristics, TAVI procedural data, and clinical outcomes were compared. Multivariate logistic regression was performed to identify predictors of periprocedural stroke. Thirty-day symptomatic stroke occurred in 1.4% of study patients. Stroke patients more frequently had previous stroke, peripheral artery disease (PAD), frailty, and higher Society of Thoracic Surgeons (STS) scores. Nearly 90% of stroke events occurred within 5 days after TAVI. Use of self-expanding (SE) valves was more common in the Stroke group (47% vs. 32%). On multivariate analysis, PAD odds ratio (OR): 1.70, 95% confidence interval (CI): 1.10-2.63, higher STS score (OR: 1.03, 95%CI: 1.00-1.05), and SE valve use (OR: 1.71, 95%CI: 1.16-2.53) were independent predictors. CONCLUSIONS In this large multicenter registry, the 30-day incidence of symptomatic stroke after TAVI was 1.4%. PAD, higher STS score, and SE valve use were independent predictors. Careful patient selection and procedural planning are warranted.