Protruding and Ulcerated Aortic Atheromas as Predictors of Periprocedural Ischemic Stroke Post-Transcatheter Aortic Valve Replacement (JACC Asia February 2025)-Article: Protruding and Ulcerated Aortic Atheromas as Predictors of Periprocedural Ischemic Stroke Post-Transcatheter Aortic Valve Replacement

Article: Protruding and Ulcerated Aortic Atheromas as Predictors of Periprocedural Ischemic Stroke Post-Transcatheter Aortic Valve Replacement

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This study explored how protruding and ulcerated aortic atheromas affect the likelihood of experiencing ischemic strokes after transcatheter aortic valve replacement (TAVR). Aortic atherosclerosis can significantly influence the strategy and outcome of TAVR procedures because the manipulation involved during the procedure can potentially cause embolisms, such as ischemic strokes, when debris dislodges from atherosclerotic aortic walls.<br /><br />Researchers conducted a retrospective study involving 977 patients who underwent TAVR between 2010 and 2019. Using contrast-enhanced CT scans, they evaluated the presence of protruding aortic atheromas (thickness ≥3 mm) and ulcerated aortic atheromas (with ulcer-like intimal disruption). The primary focus was the risk of ischemic strokes occurring within 30 days post-TAVR.<br /><br />Results indicated that patients with either protruding or ulcerated aortic atheromas had a considerably higher incidence of ischemic stroke, specifically 8% compared to 3.2% for those without such conditions. The study found a higher stroke risk particularly associated with atheromas in the aortic arch. In transfemoral TAVR using self-expandable valves, the stroke risk was notably higher in such patients (aOR: 9.04). However, this association was not as strong with balloon-expandable valves (aOR: 2.85).<br /><br />The findings underscore the need for careful procedural planning in TAVR among patients having vulnerable aortic atheromas, emphasizing the importance of a well-selected TAVR strategy, which may include opting for certain valve types and procedural approaches to mitigate stroke risk post-procedure. With an increased stroke risk tied to these atheromas, particularly in the aortic arch, alternative TAVR strategies should be considered to enhance patient safety and outcomes.

Keywords

aortic atheromas

ischemic stroke

TAVR

transcatheter aortic valve replacement

atherosclerosis

contrast-enhanced CT scans

protruding atheromas

ulcerated atheromas

self-expandable valves

balloon-expandable valves