ArticleJACC. Asia2025
Protruding and Ulcerated Aortic Atheromas as Predictors of Periprocedural Ischemic Stroke Post-Transcatheter Aortic Valve Replacement.
Article in JACC. Asia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Full Body Embolic Protection During Transcatheter Aortic Valve Replacement in High Risk Patients.JACC. Case reports · 2026Article
- Suitability for Transcarotid Transcatheter Aortic Valve Replacement in the Japanese Population.JACC. Asia · 2026Article
- Managing Hostile Aortic Anatomies Using an Extended-Length Introducer Sheath During Transfemoral Transcatheter Aortic Valve Replacement: Rationale and Clinical Outcomes.Structural heart : the journal of the Heart Team · 2025Article
- Cardiac Computed Tomography in Structural Heart Interventions: From Preprocedural Planning to Procedural Strategy.Reviews in cardiovascular medicine · 2025Review
- Stroke in Transcatheter Aortic Valve Implantation (TAVI): A Comprehensive Review.Journal of clinical medicine · 2025Review
- TAVR and Strokes: Are Aortic Atheromas Part of the Story?JACC. Asia · 2025Article
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Authors and funding
20 authors.
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Abstract
backgroundAortic atherosclerosis can affect the strategy and outcomes of transcatheter aortic valve replacement (TAVR). Limited investigation exists into how aortic atheroma morphology influences outcomes post-TAVR.
objectivesThis study aimed to assess the influence of protruding and ulcerated aortic atheromas on periprocedural ischemic stroke post-TAVR.
methodsThis analysis included 977 patients who underwent TAVR between February 2010 and May 2019, with available contrast-enhanced computed tomography data. Protruding aortic atheroma was defined as atheroma of ≥3 mm thickness with protruding components. Ulcerated aortic atheroma was defined as atheroma with ulcer-like intimal disruption. The primary endpoint was periprocedural ischemic stroke within 30 days post-TAVR.
resultsIn total, 43 (4.4%) experienced periprocedural ischemic stroke. Patients with protruding or ulcerated aortic atheroma had a significantly higher incidence of periprocedural stroke compared with those without (8.0% [95% CI: 4.9%-12.2%] vs 3.2% [95% CI: 2.1%-4.8%]; P = 0.003). Protruding or ulcerated atheroma (adjusted OR [aOR]: 2.55 [95% CI: 1.37-4.74]), particularly in the aortic arch (aOR: 3.86 [95% CI: 1.69-8.83]), independently increased periprocedural stroke risk. Among patients undergoing transfemoral TAVR with self-expandable valves (n = 315, 32%), protruding or ulcerated atheroma in the aortic arch was independently associated with periprocedural stroke (aOR: 9.04 [95% CI: 1.59-51.4]), whereas it was not among those with balloon-expandable valves (n = 580, 59%) (aOR: 2.85 [95% CI: 0.92-8.84]).
conclusionsProtruding and ulcerated aortic atheromas are associated with a higher risk of periprocedural ischemic stroke post-TAVR. Careful selection of TAVR strategy, including valve type and procedural approach, is essential for patients with such aortic lesions.
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