Key result
Patterns of calcification did not predict periprocedural stroke, though the median length of calcium protruding above the annulus was 8 mm in stroke patients versus 10.6 mm in controls.
Why the study?
Periprocedural stroke is a devastating complication of TAVI likely originating from valve emboli, and it was unknown whether specific calcification patterns can predict this risk.
Does the pattern of calcification in the aortic valve complex predict periprocedural stroke in patients undergoing TAVI?
Case-Control (n=102)
Single-blind
Does the pattern of calcification in the aortic valve complex predict periprocedural stroke in patients undergoing TAVI?
The pattern and load of calcification in the aortic valve complex on pre-procedural CT does not appear to predict the risk of periprocedural stroke during TAVI.
Pre-TAVI CT calcium patterns should not guide stroke risk assessment; leaves open alternative embolic mechanisms.
Background: Periprocedural stroke during transcatheter aortic valve implantation is a rare but devastating complication. The calcified aortic valve is the most likely source of the emboli in a periprocedural stroke. The total load and distribution of calcium in the leaflets, aortic root, and left ventricular outflow tract varies from patient to patient. Consequently, there could be patterns of calcification that are associated with a higher risk of stroke. This study aimed to explore whether the pattern of calcification in the left ventricular outflow tract, annulus, aortic valve, and ascending aorta can be used to predict a periprocedural stroke. Methods: Among the 3282 consecutive patients who received a transcatheter aortic valve implantation in the native valve in Sweden from 2014 to 2018, we identified 52 who had a periprocedural stroke. From the same cohort, a control group of 52 patients was constructed by propensity score matching. Both groups had one missing cardiac computed tomography, and 51 stroke and 51 control patients were blindly reviewed by an experienced radiologist. Results: The groups were well balanced in terms of demographics and procedural data. Of the 39 metrics created to describe calcium pattern, only one differed between the groups. The length of calcium protruding above the annulus was 10.6 mm (interquartile range 7-13.6) for patients without stroke and 8 mm (interquartile range 3-10) for stroke patients. Conclusions: This study could not find any pattern of calcification that predisposes for a periprocedural stroke.
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Bjursten et al. (2022) conducted a case-control in Transcatheter aortic valve implantation (n=102). Calcification pattern in the aortic valve, root, and left ventricular outflow tract vs. Matched controls without periprocedural stroke was evaluated on Periprocedural stroke. Patterns of calcification did not predict periprocedural stroke, though the median length of calcium protruding above the annulus was 8 mm in stroke patients versus 10.6 mm in controls.
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