Abstract 13616: Aorta Atheroma Burden Predicts Acute Cerebrovascular Events after Transcatheter Aortic Valve Implantation: Insights from Volumetric Multislice Computed Tomography Analysis

Abstract

Backgrounds: Cerebrovascular accidents (CVAs) are a major complication of transcatheter aortic valve implantation (TAVI). Proposed mechanisms include atheroembolization of debris during balloon aortic valvuloplasty, deployment of the device or catheter passage through the aorta. The relationship between aortic atheroma burden and acute CVAs after TAVI has not been established. Methods: Preoperative multislice computed tomographic (MSCT) images in 218 patients treated with TAVI were analyzed. Vessel and lumen areas in each 1-mm cross-sectional image from ascending to abdominal aorta were measured. Total atheroma volume (TAV) was calculated and compared in patients with (n=18) and without (n=200) acute CVAs. Results: Patients with acute CVAs were more likely to have a history of cerebrovascular disease (61 v. 14%, p<0.01). MSCT analysis demonstrated that patients having acute CVAs exhibited greater TAV in the ascending aorta (11.9 ± 2.4 v. 9.7 ± 2.0 cm3, p=0.02) and arch (3.1 ± 1.1 v. 2.5 ± 0.5 cm3, p=0.02) but not in the descending (p=0.93) and abdominal aorta (p=0.77). Aortic valve calcification volume did not predict CVAs. TAV in the ascending (p=0.03) and arch (p=0.02), as well as a history of cerebrovascular disease (p=0.03), were independent predictors for acute CVAs after TAVI on multivariate analysis. Receiver-operating characteristic curve analysis identified TAV in the ascending aorta >10.2 cm3 and in the arch >2.8 cm3 as the optimal cutoff for predicting acute CVAs. The incidence of acute CVA was highest (66%) if patients had a history of cerebrovascular disease and TAV in the ascending aorta and arch above these cutoff values (Figure). Conclusions: Patients with acute CVAs after TAVI harbored greater atheroma burden in the ascending aorta and aortic arch. Our finding might underscore preoperative MSCT analysis of aorta atheroma burden to identify high-risk patients for acute CVAs, who may benefit from embolic protection devices during TAVI procedure.