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DOI: 10.1055/s-0031-1297509
Relationship between atheroma of the thoracic aorta and potential stroke in patients undergoing transcatheter aortic valve implantation
Introduction: Several studies have shown a high incidence of embolic cerebral lesions in up to 84% after transcatheter implantation (T-AVI), leading to a clinical manifest stroke in 2–10%. The existence of aortic arch atheroma >4mm is known as a risk factor for spontaneous stroke. Our objective was to assess the relationship between the incidence of perinterventional TIA/stroke and severity of calcification of the aortic valve and the thoracic aorta when characterized by a quantitative approach.
Methods: 111 patients with severe aortic stenosis underwent TAVI (54 transapical, 54 transfemoral, 3 transsubclavian approach, respectively) and had Multi Slice Computed Tomogram (MSCT) screening of the aorta as part of the diagnostic evaluation. We performed quantitative analysis of calcification of the aortic valve and ascending, arch and descending aorta using the Agatston score.
Results: Patients were 82±14 years old, 62% were female and logistic Euroscore was 26±14%. Within 24h from the procedure TIA or stroke occurred in 4/111 patients (3.6%) and secondary stroke (>24h from the procedure) in 2/111 (1.8%) of patients, respectively. 5/111 (4.5%) patients suffered TIA/PRIND after 24h or later. Patients suffering of stroke/TIA had significantly higher values of Agatston Score in the aortic arch (6238±5942 vs. 3272±3038; p=0.01) and descending aorta (5286±4828 vs. 2792±3015; p=0.02), but neither at the aortic valve (2357±2206 vs. 2921±2153;p=0.43) nor at the ascending aorta (1404±1401 vs. 1206±2105; p=0.77). In congruence, plaque protrusion into the lumen of the aorta was larger in the stroke/TIA group, reaching statistical significance atthe aortic arch (4.7±1.6mm vs. 3.1±1.6mm; p=0.003), but not in the ascending aorta (3.5±2.0mm vs. 2.7±1.6mm; p=0.14).
Conclusions: This study confirms that the extent and the protrusion of calcifications at the aortic arch and the descending aorta are significantly related to an adverse neurological outcome after T-AVI. Precise preoperative screening may lead to optimized clinical solutions in these patients, for example use of protection devices.