Cerebral Embolism: A Silent Iatrogenic Complication of TAVR That Needs Voiced Consideration.

SEE PAGE 589 T ranscatheter aortic valve replacement (TAVR) has rapidly and definitely changed the way patients with aortic stenosis are treated. Both the number of procedures and the indications have increasedworldwide, allowing the inoperable patient to be treated, the high risk patient to be treated less invasively, and the intermediate risk patient to have the choice of an alternative to surgery (1–4). Clinical stroke or transient ischemic attack is not uncommon after aortic stenosis treatment, ranging in the randomized studies from 5% to 6% at 30 days to 8% to 10% at 1 year—one-half of them being major/ disabling strokes (Table 1). Current registry data report a 3.5% stroke rate at 30 days, which represents almost a 50% decrease as compared to early experience with TAVR (5). In addition, stroke related to TAVR appears to be less frequent than stroke with surgical aortic replacement (3). However, clinical stroke is only the emerging part of the iceberg. Silent cerebral embolism