TEER with Abbott’s MitraClip linked to low stroke risk, new study confirms
![Treating mitral regurgitation with transcatheter mitral edge-to-edge repair (TEER) using the MitraClip device is associated with a low risk of cerebrovascular accidents (CVAs) such as stroke and transient ischemic attack (TIA), according to new data published in The American Journal of Cardiology.[1]](/sites/default/files/styles/top_stories/public/2024-08/small-tech-big-impact-mitraclip-960x430.jpg.webp?itok=SWlQGHuS)
Treating mitral regurgitation with transcatheter mitral edge-to-edge repair (TEER) using the MitraClip device is associated with a low risk of cerebrovascular accidents (CVAs) such as stroke and transient ischemic attack (TIA), according to new data published in The American Journal of Cardiology.[1]
“Mitral regurgitation is a common cause of morbidity and mortality,” wrote first author Arturo Giordano, MD, PhD, a cardiologist with Pineta Grande Hospital in Italy, and colleagues. “While surgical repair represents the gold standard for such disease, it is associated with significant complications in frail patients. Minimally invasive alternatives to surgical repair have been identified, and transcatheter mitral valve repair approaches may offer significant benefits in patients at increased surgical risk. TEER, in particular, appears as a clinically useful technique with a low risk of acute and post-acute complications.”
The authors noted that some studies have suggested TEER may increase a patient’s vulnerability to stroke and TIAs. To learn more, the group evaluated data from more than 2,200 patients with significant mitral regurgitation treated with TEER under transesophageal echocardiogram (TEE) guidance. All patients were treated with Abbott’s MitraClip device, arguably the world’s most well-known TEER device. Data came from the GIOTTA registry, which is sponsored by the Italian Society of Invasive Cardiology.
Overall, just 1.5% of patients experienced a CVA after a median follow-up period of 14 months. A majority of the reported incidents were ischemic strokes. The CVA risk increased when patients presented with atrial fibrillation (AFib), renal dysfunction, a higher EuroSCORE II or higher CHA2DS2-VASc score.
The authors did emphasize, however, that CHA2DS2-VASc score did not prove to be good predictors for when a patient may experience a post-TEER stroke or TIA. In addition, experiencing a CVA did not appear to significantly increase a patient’s short-term risk of adverse outcomes, but the data did suggest that CVA may increase a patient’s mid-term risk of death or other poor outcomes.
Giordano et al. also wrote that AFib was bound to increase a patient’s stroke risk, “both acutely and chronically.” Patients should be proactively treated with anticoagulant therapy—or even left atrial appendage occlusion (LAAO) when necessary—to help manage this risk, the group added.
“Future research on the topic of stroke risk in patients undergoing TEER with MitraClip should explore the development of refined risk prediction models that incorporate a wider range of clinical and procedural variables to better identify patients at high risk for CVA, including follow-up monitoring,” the authors concluded. “Investigating the optimal antithrombotic therapy regimens and their timing relative to the procedure could offer insights into minimizing post-procedural CVA risk while balancing bleeding risks. Additionally, longitudinal studies focusing on the long-term neurocognitive outcomes of patients experiencing CVA after TEER would provide valuable information on patient quality of life and help tailor post-procedure care and surveillance strategies. Another intriguing avenue for research and practice is transcatheter LAAO in patients with AFib and increased surgical risk, before, during or after TEER.”
Abbott, the company behind the MitraClip technology, did help fund the GIOTTA registry. In addition, some authors had prior relationships with Abbott.
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.