Overall, after a median follow-up of 14 months, only 1.5% of patients suffered a stroke. Most of the reported events were ischemic strokes. The risk of stroke increased if patients had atrial fibrillation (AFib), renal impairment, a higher EuroSCORE II or a higher CHA value.2DS2-VASc result.
However, the authors stressed that the CHA2DS2-VASc score was not a good predictor of when a patient might experience a stroke or TIA after TEER. In addition, a CVA did not appear to significantly increase a patient’s short-term risk of adverse outcomes, but the data suggested that a CVA could increase a patient’s medium-term risk of death or other adverse outcomes.
Giordano et al also wrote that atrial fibrillation increases a patient’s risk of stroke “both acutely and chronically.” To control this risk, patients should be proactively treated with anticoagulants – or even left atrial appendage occlusion (LAAO) if necessary, the group added.
“Future research on stroke risk in patients undergoing TEER with MitraClip should explore the development of refined risk prediction models that consider a broader range of clinical and procedural variables to better identify patients at high risk for CVA, including follow-up,” the authors concluded. “Investigating optimal antithrombotic therapy regimens and their timing relative to the procedure could provide insights into minimizing CVA risk post-procedure while balancing bleeding risk. In addition, longitudinal studies focusing on long-term neurocognitive outcomes of patients with CVA after TEER would provide valuable information on patient quality of life and help tailor follow-up and monitoring strategies. Another interesting approach for research and practice is transcatheter LAAO in patients with atrial fibrillation and increased surgical risk before, during, or after TEER.”
Abbott, the company behind the MitraClip technology, provided financial support to the GIOTTA registry. In addition, some authors had previous relationships with Abbott.
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