Association between aortic arch atheroma and periprocedural stroke following transcatheter aortic valve implantation

Abstract Background and Aims This study examined the impact of aortic arch atheroma severity on the risk of periprocedural stroke following transcatheter aortic valve implantation (TAVI). Methods and results We retrospectively evaluated contrast-enhanced computed tomography data of patients who underwent transfemoral-TAVI from May 2016 to March 2024. Aortic arch atheroma was classified into none/mild maximum plaque thickness (MPT) 3 mm, moderate (MPT 3–5 mm), severe (MPT 5 mm without shaggy morphology), and shaggy (MPT 5 mm with shaggy morphology). The primary outcome measure was periprocedural (30-day) ischaemic stroke following TAVI. Of the 1971 eligible patients, 65 (3.3%) experienced periprocedural ischaemic stroke. Compared with none/mild atheroma, moderate atheroma adjusted odds ratio (aOR) 2.93; 95% confidence interval (CI), 1.63–5.28; P .001 and shaggy atheroma (aOR 14.58; 95% CI, 6.67–31.87; P .001) were independently associated with increased risk of periprocedural stroke. Severe atheroma exhibited a similar trend, albeit without statistical significance (aOR 2.81; 95% CI, 0.92–8.61; P = .07). In the balloon-expandable transcatheter heart valve (BE-THV) cohort, stroke incidence was significantly increased only in the shaggy group (1.1% vs. 2.8% vs. 1.4% vs. 11.9%, P .001); however, stroke incidence across the atheroma severity groups in the self-expandable THV (SE-THV) cohort demonstrated a stepwise increase (2.8% vs. 8.2% vs. 13.6% vs. 33.3%, P .001). Conclusions Aortic arch atheroma severity was associated with an increased risk of periprocedural stroke following transfemoral-TAVI, with the impact being more pronounced in patients treated with SE-THV than in those treated with BE-THV.