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经导管主动脉瓣置换术后卒中的进展

[Advances in stroke after transcatheter aortic valve replacement].

作者信息

Zhou Yue, Yang Renqiang

机构信息

Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Nanchang 330008, China.

出版信息

Zhejiang Da Xue Xue Bao Yi Xue Ban. 2025 Mar 25;54(2):167-174. doi: 10.3724/zdxbyxb-2024-0414.


DOI:10.3724/zdxbyxb-2024-0414
PMID:40231704
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12062942/
Abstract

With the clinical generalization and popularization of transcatheter aortic valve replacement (TAVR), cerebrovascular events related to TAVR occur more frequently, which significantly impairs neurocognitive function, increases mortality, and seriously affects prognosis and quality of life in these patients. However, the reported incidence rates of TAVR-related stroke differ in literature due to inconsistent diagnostic criteria. According to the onset time, TAVR-related stroke can be divided into acute (≤24 h), subacute (24 h-30 d), early (31 d-1 year) and late (>1 year) types, and the cause of stroke generally varies according to the onset time. Both surgical (balloon aortic valvuloplasty, types of transcatheter heart valve, alternative access) and non-surgical (valvular calcium burden, bicuspid aortic valve, subclinical leaflet thrombosis, postoperative new-onset atrial fibrillation) can be related to the occurrence of TAVR-related stroke. Postprocedural monitoring, postprocedural antithrombotic therapy, and cerebral embolic protection devices are important for the prevention of TAVR-related stoke. This article reviews the research progress on TAVR-related stroke, focusing on its epidemiology, risk factors and preventive measures, aiming to provide reference for the clinical management of stroke in TAVR.

摘要

随着经导管主动脉瓣置换术(TAVR)的临床推广和普及,与TAVR相关的脑血管事件愈发频繁地发生,这严重损害了神经认知功能,增加了死亡率,并严重影响这些患者的预后和生活质量。然而,由于诊断标准不一致,文献报道的TAVR相关卒中的发生率有所不同。根据发病时间,TAVR相关卒中可分为急性(≤24小时)、亚急性(24小时至30天)、早期(31天至1年)和晚期(>1年)类型,且卒中原因通常随发病时间而异。手术因素(球囊主动脉瓣成形术、经导管心脏瓣膜类型、替代入路)和非手术因素(瓣膜钙化负荷、二叶式主动脉瓣、亚临床瓣叶血栓形成、术后新发房颤)均可能与TAVR相关卒中的发生有关。术后监测、术后抗栓治疗以及脑栓塞保护装置对于预防TAVR相关卒中至关重要。本文综述了TAVR相关卒中的研究进展,重点关注其流行病学、危险因素及预防措施,旨在为TAVR中卒中的临床管理提供参考。

相似文献

[1]
[Advances in stroke after transcatheter aortic valve replacement].

Zhejiang Da Xue Xue Bao Yi Xue Ban. 2025-3-25

[2]
The risk and extent of neurologic events are equivalent for high-risk patients treated with transcatheter or surgical aortic valve replacement.

J Thorac Cardiovasc Surg. 2016-7

[3]
Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Replacement: A Review.

Stroke. 2024-11

[4]
Novel Cerebral Protection Technique During Right Transcarotid TAVR in Bicuspid Aortic Stenosis and Porcelain Aorta.

J Invasive Cardiol. 2018-11

[5]
Cerebral embolic protection systems for transcatheter aortic valve replacement.

J Interv Cardiol. 2018-12

[6]
Neurologic Complications in Transcatheter Aortic Valve Replacement.

Interv Cardiol Clin. 2021-10

[7]
Analysis of Neurologic Complications After Surgical Versus Transcatheter Aortic Valve Replacement.

J Cardiothorac Vasc Anesth. 2018-11-14

[8]
Meta-Analysis of Stroke and Mortality Rates in Patients Undergoing Valve-in-Valve Transcatheter Aortic Valve Replacement.

J Am Heart Assoc. 2021-3-16

[9]
Neurological Complications After Transcatheter Aortic Valve Replacement: A Review.

Anesth Analg. 2024-11-1

[10]
Incidence and causes of silent and symptomatic stroke following surgical and transcatheter aortic valve replacement: a comprehensive review.

Interact Cardiovasc Thorac Surg. 2016-9

本文引用的文献

[1]
Valve Thrombosis Following Transcatheter Aortic Valve Replacement: State-of-the-Art Review.

Catheter Cardiovasc Interv. 2025-3

[2]
Paravalvular regurgitation after transcatheter aortic valve replacement: incidence, quantification, and prognostic impact.

Eur Heart J Imaging Methods Pract. 2024-5-3

[3]
Cerebrovascular events after transcatheter aortic valve implantation.

EuroIntervention. 2024-7-1

[4]
Impact of balloon post-dilation on valve durability and long-term clinical outcomes after self-expanding transcatheter aortic valve implantation.

Catheter Cardiovasc Interv. 2024-1

[5]
Subclinical Leaflet Thrombosis Following Surgical and Transcatheter Aortic Valve Replacement: A Meta-Analysis.

Am J Cardiol. 2023-10-1

[6]
Comparison of Outcomes Following Transcatheter Aortic Valve Replacement Requiring Peripheral Vascular Intervention or Alternative Access.

J Am Heart Assoc. 2023-6-20

[7]
Vascular Access in Patients With Peripheral Arterial Disease Undergoing TAVR: The Hostile Registry.

JACC Cardiovasc Interv. 2023-2-27

[8]
Routine cerebral embolic protection in transcatheter aortic valve implantation: rationale and design of the randomised British Heart Foundation PROTECT-TAVI trial.

EuroIntervention. 2023-4-24

[9]
The Relationship Between Hospital Stroke Center Designation and TVT Reported Stroke: The Michigan TAVR Experience.

JACC Cardiovasc Interv. 2023-1-23

[10]
Subclinical leaflet thrombosis after transcatheter aortic valve implantation is associated with silent brain injury on brain magnetic resonance imaging.

Eur Heart J Cardiovasc Imaging. 2022-11-17

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