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

Figures

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  Central Illustration. Aortic Atheromas and Periprocedural Ischemic Stroke Post-Transcatheter Aortic Valve Replacement The frequencies of protruding or ulcerated aortic atheromas, which are shown in (A) and (B), were as follows: 0.2% in the ascending aorta, 6.5% in the aortic arch, 11.1% in the descending aorta, 15.7% in the abdominal aorta, and 24.3% in the entire aorta. The frequency of aortic atheroma of ≥5 mm was also 0.1%, 4.4%, 10.6%, 16.3%, and 22.3%, respectively. (C) Patients with protruding or ulcerated aortic atheroma had a significantly higher incidence of periprocedural ischemic stroke compared with those without. (D) There was no significant difference in the incidence of periprocedural ischemic stroke according to aortic atheroma thickness. Parentheses contain 95% CIs. TAVR = transcatheter aortic valve replacement.

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  Figure 1. Incidence of Acute Ischemic Stroke According to Aortic Atheroma Morphology (A to D) Patients with protruding or ulcerated atheroma in the entire aorta, aortic arch, and abdominal aorta, had a significantly higher incidence of acute ischemic stroke compared with those without. (E to H) Atheroma thickness in the aortic arch was also related to acute ischemic stroke. Parentheses contain 95% CIs.

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  Figure 2. Acute Stroke and Vulnerable Aortic Atheroma: Self- vs Balloon-Expandable Valves (A and C) Among patients undergoing transfemoral transcatheter aortic valve replacement (TF-TAVR) with self-expandable valves, those with protruding or ulcerated aortic atheroma, particularly in the aortic arch, had a notably higher incidence of acute ischemic stroke compared with those without. (B and D) Among patients undergoing TF-TAVR with balloon-expandable valves, no significant difference in the incidence of acute ischemic stroke was observed between patients with and without protruding or ulcerated aortic atheroma. Parentheses contain 95% CIs.

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  Figure 3. Periprocedural Stroke and Aortic Atheroma Morphology in Each Aortic Segment (A to C) Patients with protruding or ulcerated atheroma in the aortic arch had a higher incidence of periprocedural ischemic stroke compared with those without. (D to F) There was no significant difference in the incidence of periprocedural ischemic stroke according to aortic atheroma thickness in any aortic segments. Parentheses contain 95% CIs.