Clinical predictors for procedural stroke and implications for embolic protection device during TAVR: Results from the multicenter Transcatheter Aortic valve replacement in-hoSpital stroKe (TASK) study

Anat Berkovitch ^1,2 Amit Segev ^1,2 Elad Maor ^1,2 Alexander Sedaghat ³ Ariel Finkelstein ^2,4 Matteo Saccocci ⁵ Ran Kornowski ^2,6 Azeem Latib ⁷ Jose M. De la Torre Hernandez ⁹ Lars Søndergaard ¹⁰ Darren Mylotte ¹¹ Niels van Royen ¹² Azfar G. Zaman ¹³ Pierre Robert ¹⁴ Jan-Malte Sinning ³ Arie Steinvil ^2,4 Francesco Maisano ⁵ Katia Orvin ^2,6 Gianmarco Iannopollo ⁸ Dae Hyun-Lee ⁹ Ole De Backer ¹⁰ Federico Mercanti ¹⁵ Kees van der Wulp ¹² Joy Shome ¹³ Didier Tchétché ¹⁴ Israel M. Barbash ^1,2

¹Interventional Cardiology Unit, Leviev Heart and Vascular Center, Chaim Sheba Medical Center, Israel
²Sackler School of Medicine, Tel-Aviv University, Israel
³Heart Center Bonn, University Hospital Bonn, Germany
⁴Division of Cardiology, Tel Aviv Medical Center, Israel
⁵Cardiovascular Surgery Department, University Hospital of Zurich, Switzerland
⁶Division of Cardiology, Rabin Medical Center, Israel
⁷Department of Cardiology, Montefiore Medical Center. New York, USA
⁸Interventional Cardiology Unit, San Raffaele Hospital, Italy
⁹Interventional Cardiology Department, Hospital Universitario Marques de Valdecilla, INDIVAL, Spain
¹⁰The Heart Center, Rigshospitalet, Denmark
¹¹University Hospital and SAOLTA Health Care Group, National University of Ireland, Ireland
¹²Department of Cardiology, Radboud University Medical Center, Netherlands
¹³Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, UK
¹⁴Department of Interventional Cardiology, Clinique Pasteur, France
¹⁵Division of Cardiology, University of Rome Tor Vergata, Italy

Background: Routine use of embolic protection devices (EPD) for stroke prevention during transcatheter aortic valve replacement (TAVR) is controversial. Identifying patients at high risk for peri-procedural cerebrovascular events (CVE) may facilitate effective patient selection for EPD and stroke prevention.

Aim: To generate a risk score model for stratifying TAVR patients according to peri-procedural CVE risk.

Methods and results Included were 8,779 patients who underwent TAVR in 12 centers worldwide. Peri-procedural CVE was defined as a ischemic stroke or a transient ischemic attack occurring ≤24 hours from TAVR. Peri-procedural CVE rate was 1.4% (n = 127), and it was independently associated with 1-year mortality (hazards ratio [HR] 1.78, 95% confidence interval [CI] 1.06-2.98, P < 0.028). The TASK risk score items were history of stroke, use of a non-balloon expandable valve, chronic kidney disease, and peripheral vascular disease, and each was assigned one point. Each one-point increment was associated with a significant increase in peri-procedural CVE risk (OR 1.96, 95%CI 1.56-2.45, P < 0.001). The TASK score was dichotomized to low, intermediate, and high risk groups for peri-procedural CVE (0, 1-2, 3-4 points, respectively). High-risk TASK score group (OR 5.4, 95%CI 2.06-14.16, P = 0.001) was associated with a significantly higher risk of peri-procedural CVE compared with low TASK score group.

Conclusions The proposed novel TASK risk score may assist in pre-procedural, risk stratification of TAVR patients for peri-procedural CVE.

Stroke risk according to TASK score