title: Aortic atheroma burden predicts acute cerebrovascular events after transcatheter aortic valve implantation: insights from volumetric multislice computed tomography analysis.
abstract: OBJECTIVE
  Embolisation of atheromatous debris during catheter manipulation is considered to underlie acute cerebrovascular events (CVE) after transcatheter aortic valve implantation (TAVI). However, the relationship between aorta atheroma burden and acute CVE after TAVI has not been established. We investigated the impact of aorta atheroma burden on acute CVE.
  
  
  RESULTS
  Preoperative multislice computed tomographic (MSCT) images in 278 patients receiving TAVI were analysed. Total atheroma volume (TAV) was calculated by measuring aorta vessel and lumen areas in every 1 mm cross-sectional image. Acute CVE was observed in 16 patients. Patients having acute CVE were more likely to have a prior CVE (p=0.002), and to exhibit greater TAV in the ascending aorta (12.8±3.5 vs. 7.0±2.1 cm3, p<0.001) and the aortic arch (3.1±1.6 vs. 1.2±0.2 cm3, p<0.001). TAV in the ascending aorta >10.3 cm3 and in the aortic arch >2.9 cm3 predicted acute CVE. The incidence of acute CVE was highest (36.4%) if patients had a prior CVE and TAV in the ascending aorta and the aortic arch above cut-offs.
  
  
  CONCLUSIONS
  Patients with acute CVE after TAVI had greater aorta atheroma burden. Our findings might underscore preoperative MSCT analysis of aorta atherosclerosis to identify high-risk patients for acute CVE, who might require an embolic protection device during TAVI.
authors.affiliation: South Australian Health & Medical Research Institute, University of Adelaide, Adelaide, Australia.
authors.forename: Yu
authors.initials: Y
authors.lastname: Kataoka
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Pisaniello
authors.forename: Muhammad
authors.initials: M
authors.lastname: Hammadah
authors.forename: Mohammed
authors.initials: M
authors.lastname: Qintar
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Uno
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Montarello
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholls
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Worthley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D054893:Cone-Beam Computed Tomography; D005260:Female; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D015588:Observer Variation; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000000981:diagnostic imaging; D011446:Prospective Studies; D013021:South Australia / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000706:statistics & numerical data