Computed tomography defined femoral artery plaque composition predicts vascular complications during transcatheter aortic valve implantation

Elliott J. Carande; Tarik S Salim; Alexander Chase; Baskar Sekar; Omar Aldalati; Ahmed Hailan; Ayush Khurana; Dave Smith; Daniel R. Obaid

doi:10.1259/bjr.20230296

September 25, 2023British Journal of RadiologyOpen Access

Computed tomography defined femoral artery plaque composition predicts vascular complications during transcatheter aortic valve implantation

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Why the study?

Vascular and bleeding complications after TAVI are common and increase morbidity and mortality, and analysis of plaque at the arterial access site may improve risk prediction.

Does CT-derived necrotic core volume predict VARC-3 vascular complications in patients undergoing transfemoral TAVI?

Structured PICO

Does CT-derived necrotic core volume predict VARC-3 vascular complications in patients undergoing transfemoral TAVI?

P

Population

299 patients undergoing transfemoral TAVI with use of a vascular closure device (ProGlide® or MANTA®)

I

Intervention

Pre-procedure femoral CT angiography with plaque map analysis to quantify necrotic core volume of the common femoral artery

O

Outcome

Valve Academic Research Consortium (VARC-3) vascular complicationssafety

CT-derived necrotic core volume in the common femoral artery is a strong predictor of vascular complications following transfemoral TAVI.

Implication

Does not yet support routine CT plaque analysis for TAVI access planning; leaves open its predictive utility pending validation.

Abstract

Objective: Vascular and bleeding complications after transcatheter aortic valve implantation (TAVI) are common and lead to increased morbidity and mortality. Analysis of plaque at the arterial access site may improve prediction of complications. Methods: We investigated the association between demographic and procedural risk factors for Valve Academic Research Consortium (VARC-3) vascular complications in patients undergoing transfemoral TAVI with use of a vascular closure device (ProGlide® or MANTA®) in this retrospective cohort study. The ability of pre-procedure femoral CT angiography to predict complications was investigated including a novel method of quantifying plaque composition of the common femoral artery using plaque maps created with patient specific X-ray attenuation cut-offs. Results: 23 vascular complications occurred in the 299 patients in the study group (7.7%). There were no demographic risk factors associated with vascular complications and no statistical difference between use of closure device (ProGlide®vs MANTA®) and vascular complications. Vascular complications after TAVI were associated with sheath size (OR 1.36, 95% CI 1.08–1.76, P 0.01) and strongly associated with CT-derived necrotic core volume in the common femoral artery of the procedural side (OR 17.49, 95% CI 1.21–226.60, P 0.03). Conclusion: Plaque map analysis of the common femoral artery by CT angiography reveals patients with greater necrotic core are at increased risk of VARC-3 vascular complications. Advances in knowledge: The novel measurement of necrotic core volume in the common femoral artery on the procedural side by CT analysis was associated with post-TAVI vascular complications, which can be used to highlight increased risk.