TY - JOUR
T1 - Aortic atheroma burden predicts acute cerebrovascular events after transcatheter aortic valve implantation
T2 - Insights from volumetric multislice computed tomography analysis
AU - Kataoka, Yu
AU - Puri, Rishi
AU - Pisaniello, Anthony D.
AU - Hammadah, Muhammad
AU - Qintar, Mohammed
AU - Uno, Kiyoko
AU - Montarello, Joseph K.
AU - Nicholls, Stephen J.
AU - Worthley, Stephen G.
N1 - Publisher Copyright:
© Europa Digital & Publishing 2016. All rights reserved.
PY - 2016/8
Y1 - 2016/8
N2 - Aims: Embolisation of atheromatous debris during catheter manipulation is considered to underlie acute cerebrovascular events (CVE) after transcatheter aortic valve implantation (TAVI). However, the relationship between aorta atheroma burden and acute CVE after TAVI has not been established. We investigated the impact of aorta atheroma burden on acute CVE. Methods and results: Preoperative multislice computed tomographic (MSCT) images in 278 patients receiving TAVI were analysed. Total atheroma volume (TAV) was calculated by measuring aorta vessel and lumen areas in every 1 mm cross-sectional image. Acute CVE was observed in 16 patients. Patients having acute CVE were more likely to have a prior CVE (p=0.002), and to exhibit greater TAV in the ascending aorta (12.8±3.5 vs. 7.0±2.1 cm3, p<0.001) and the aortic arch (3.1±1.6 vs. 1.2±0.2 cm3, p<0.001). TAV in the ascending aorta >10.3 cm3 and in the aortic arch >2.9 cm3 predicted acute CVE. The incidence of acute CVE was highest (36.4%) if patients had a prior CVE and TAV in the ascending aorta and the aortic arch above cut-offs. Conclusions: Patients with acute CVE after TAVI had greater aorta atheroma burden. Our findings might underscore preoperative MSCT analysis of aorta atherosclerosis to identify high-risk patients for acute CVE, who might require an embolic protection device during TAVI.
AB - Aims: Embolisation of atheromatous debris during catheter manipulation is considered to underlie acute cerebrovascular events (CVE) after transcatheter aortic valve implantation (TAVI). However, the relationship between aorta atheroma burden and acute CVE after TAVI has not been established. We investigated the impact of aorta atheroma burden on acute CVE. Methods and results: Preoperative multislice computed tomographic (MSCT) images in 278 patients receiving TAVI were analysed. Total atheroma volume (TAV) was calculated by measuring aorta vessel and lumen areas in every 1 mm cross-sectional image. Acute CVE was observed in 16 patients. Patients having acute CVE were more likely to have a prior CVE (p=0.002), and to exhibit greater TAV in the ascending aorta (12.8±3.5 vs. 7.0±2.1 cm3, p<0.001) and the aortic arch (3.1±1.6 vs. 1.2±0.2 cm3, p<0.001). TAV in the ascending aorta >10.3 cm3 and in the aortic arch >2.9 cm3 predicted acute CVE. The incidence of acute CVE was highest (36.4%) if patients had a prior CVE and TAV in the ascending aorta and the aortic arch above cut-offs. Conclusions: Patients with acute CVE after TAVI had greater aorta atheroma burden. Our findings might underscore preoperative MSCT analysis of aorta atherosclerosis to identify high-risk patients for acute CVE, who might require an embolic protection device during TAVI.
KW - Aortic valve implantation
KW - Aortic valve stenosis
KW - Atherosclerosis
KW - Computed tomography
KW - Stroke
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U2 - 10.4244/EIJV12I6A127
DO - 10.4244/EIJV12I6A127
M3 - Article
C2 - 27542792
AN - SCOPUS:84983032665
SN - 1774-024X
VL - 12
SP - 783
EP - 789
JO - EuroIntervention
JF - EuroIntervention
IS - 6
ER -