Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Clin Res Cardiol. 2022 Aug;111(8):843-858. doi: 10.1007/s00392-022-01997-1. Epub 2022 Mar 17.
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.
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.
Twenty-three studies including 399,491 TAVI patients were included, 6370 from RCTs, 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 6.36% 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%).
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.
经导管主动脉瓣置换术（TAVI）治疗的患者最担心的潜在并发症之一是围手术期卒中。本研究旨在调查 TAVI 患者脑血管事件的发生率和术后神经检查的影响。
根据 PRISMA 指南进行系统评价和荟萃分析。在公共领域的 Medline 和 Clinicaltrials.gov 上进行了三次独立的电子搜索，以确定 TAVI 手术患者随机对照试验（RCT）和登记处 30 天内卒中的发生率。进行荟萃分析以评估 RCT 中 30 天内卒中的发生率。此外，我们汇总了进行或未进行计划神经检查的 RCT，以调查这种干预的效果。
共纳入 23 项研究，包括 399491 例 TAVI 患者，其中 6370 例来自 RCT，833 例来自脑栓塞保护装置 RCT，392288 例来自登记处。所有研究中 30 天卒中的平均发生率为 2.33%。在评估 TAVI 的 RCT 中，卒中发生率的合并值为 3.86%，在专门针对 CEP 的 RCT 中为 6.36%，在登记处为 2.29%。10 项 RCT 进行了计划的神经检查，这些研究的发生率为 4.03%，其余 RCT 的发生率为 2.47%。在荟萃分析中，30 天卒中的合并发生率为 3.61%（95%CI 2.57-4.79%）。
本系统评价表明，TAVI 后卒中的发生率因研究设计和神经随访方式的不同而有很大差异。强化神经检测会增加 TAVI 后卒中的发生率。
