-Assess outcomes following acute reperfusion therapy. 

From January 2012 to December 2017, 1717 patients underwent TAVR at a single tertiary center. Perioperative stroke was defined as stroke within 14 days of surgery. LVOs (internal carotid, middle cerebral (M1 or M2), basilar or posterior cerebral artery occlusions) were detected using CTA or MRA. Acute reperfusion therapy was intravenous alteplase (IV tPA) and mechanical thrombectomy (MT). Outcome variables were recanalization after thrombolysis (TICI grading system) and NIHSS after intervention or upon hospital discharge (whichever was lower). 

Overall, 107 (6.2%) TAVR patients developed perioperative ischemic strokes. Among those, 6 had LVOs with occlusions in L M1 (n=3), L M2 (n=1), R M2 (n=1), L P1 (n=1). Four underwent MT, with only one receiving IV tPA beforehand. Three patients achieved TICI 2B and one achieved TICI 3 recanalization. Two patients worsened following reperfusion therapy, including the patient that received both IV tPA and thrombectomy (pre-MT NIHSS of 19, post-MT NIHSS of 21). The patients that improved had post-MT NIHSS of 0 and 2, (initial NIHSS 21 and 7 respectively). Two of the clots were sent for histopathological examination (one reported as frank calcification, and the other as fibrin-rich thrombus). 

In our cohort, the prevalence of TAVR-associated LVO ischemic strokes was 6%. Outcomes after recanalization were variable. Factors affecting outcomes may have been IV tPA eligibility, stroke severity at onset and degree of reperfusion achieved. Further studies are needed to better understand the true real world prevalence of LVOs after TAVR and the factors affecting outcome variability.