Key result
Aortic arch morphology, including bovine arch anatomy, showed no significant association with the occurrence of periprocedural ischemic stroke in patients undergoing transcatheter aortic valve replacement.
Why the study?
Stroke after TAVR remains a concerning complication, and the influence of aortic arch morphology on periprocedural ischemic stroke risk is unclear.
Does aortic arch morphology influence the occurrence of periprocedural ischemic stroke in patients undergoing transfemoral TAVR?
Case-Control (n=201)
No
Does aortic arch morphology influence the occurrence of periprocedural ischemic stroke in patients undergoing transfemoral TAVR?
Aortic arch geometry assessed by pre-procedural MSCT does not appear to correlate with the risk of periprocedural stroke during transfemoral TAVR.
Answers are grounded in this paper and cite their sources.
Arch anatomy does not appear to predict periprocedural stroke in transfemoral TAVR; hypothesis-generating and should not yet change practice.
Objectives: Stroke after transcatheter aortic valve replacement (TAVR) continues to be one of the most concerning complications. Anatomical variations of the aortic arch may increase the risk of embolic debris entering the brain during transfemoral catheter manipulation. We aimed to analyze the influence of aortic arch morphology on the occurrence of ischemic stroke during TAVR. Methods: We performed a retrospective, 1:2 propensity-matched case–control study to compare patients with and without periprocedural stroke (defined according to the Valve Academic Research Consortium III endpoints) after transfemoral TAVR between June 2007 and September 2022. Multi-slice computed tomography (MSCT) analysis of pre-TAVR aortograms was performed to investigate arch anatomy, configuration, curvature, and the take-off angles of the epi-aortic vessels. Results: A total of 2371 patients were enrolled in this study. Periprocedural ischemic stroke was observed in 67 patients. After propensity score matching, this study included 201 patients: 67 (case) vs. 134 (control). The mean age was 80.0 ± 13.2 and 81.6 ± 6.4 years (p = 0.5), and the mean Euroscore II was 4.1 ± 3.6 and 4.3 ± 41 (p = 0.7). There was no difference in arch anatomy (p = 0.2) and configuration (p = 0.8) between the groups. Arch curvature (p = 0.9) and angulation of the brachiocephalic (p = 0.3) and left common carotid artery (p = 0.058) also did not differ significantly between the case and control groups. Conclusions: MSCT analysis in this propensity score-matched study found no correlation between aortic arch geometry and TAVR-associated stroke.
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Rusa et al. (2025) conducted a case-control in Transcatheter aortic valve replacement (TAVR) (n=201). Bovine aortic arch anatomy vs. Normal aortic arch anatomy was evaluated on Frequency of bovine arch anatomy (p=0.2). Aortic arch morphology, including bovine arch anatomy, showed no significant association with the occurrence of periprocedural ischemic stroke in patients undergoing transcatheter aortic valve replacement.
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