Stroke: an infrequent but devastating complication in cardiovascular interventions.

Stroke is a dreadful complication of cardiovascular interventions owing to the clinical manifestations of neurological deficits and the impact on prognosis (Table). Whereas the risk of cerebrovascular events (CVE) is exceedingly low among patients undergoing percutaneous coronary intervention (0.3%),1 it does range from 1.2% to 3.8% among patients undergoing isolated coronary artery bypass grafting,1,2 and is as high as 9.7% among patients undergoing double or triple valve surgery.2 Although transcatheter aortic valve implantation (TAVI) shares many features of a minimal-invasive treatment with other percutaneous techniques, this advantage does not extend to the risk of stroke, which occurs with a frequency of 2.7% to 4.2%.3 In the randomized Placement of Aortic Transcatheter Valves (PARTNER) Trial cohort 1A, rates of stroke and transient ischemic attack were higher among patients undergoing TAVI compared with surgical aortic valve replacement at 30 days (4.6% versus 2.4%; P 0.12), 1 year (8.7% versus 4.3%; P 0.03), and 2 years (11.2% versus 6.5%; P 0.05) of follow-up.4 Similarly, TAVI was associated with an increased risk of CVE compared with medical treatment in the randomized PARTNER 1B study at 30 days (6.7% versus 1.7%, P 0.02), 1 year (11.2 versus 5.5%, P 0.06) and 2 years of follow-up (13.8% versus 5.5%, P 0.01).5