Aortic Valve Calcium Score Is Associated With Acute Stroke in Transcatheter Aortic Valve Replacement Patients

Foley, Michael R.; Hall, Kerry; Howard, James P.; Ahmad, Yousif; Gandhi, M J; Mahboobani, Samir; Okafor, Joseph; Rahman, Haseeb; Hadjiloizou, Nearchos; Ruparelia, Neil; Mikhail, Ghada; Malik, Iqbal; Kanaganayagam, Gajen; Sutaria, Nilesh; Rana, Bushra S.; Ariff, Ben; Barden, Edward; Anderson, Jonathan; Afoke, Jonathan; Petraco, Ricardo; Al‐Lamee, Rasha; Sen, Sayan

doi:10.1016/j.jscai.2022.100349

Cited by 6 publications

(7 citation statements)

References 34 publications

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“…One study with transcranial Doppler in TAVI showed that cerebral embolism often occurs during prosthetic valve positioning and valve deployment [ 10 ]. Aortic valve calcium score, measured by CT, has been reported to be an independent risk factor for TAVI-related stroke [ 11 ]. Our case had a high aortic valve calcium score of 3140 Agatston units, suggesting that the patient was at a high risk of stroke.…”

Section: Discussionmentioning

confidence: 99%

Bilateral multiple stroke, left upper extremity ischemia, and transient complete atrioventricular block in transcatheter aortic valve implantation: a case report

Mitsuta,

Nakamura,

Uemura

et al. 2023

JA Clin Rep

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Background Transcatheter aortic valve implantation (TAVI) is a minimally invasive surgery. However, there is a risk of surgical manipulation causing detachment of a lesion of the aortic valve, which can result in various embolisms. Case presentation An 87-year-old woman with symptomatic severe aortic valve stenosis was scheduled for transfemoral TAVI under monitored anesthesia. Preoperative examination revealed severe calcification of the aortic valve, but there was no calcification in the ascending aorta. After a delivery catheter system passed the aortic valve, left radial arterial pressure dropped significantly, and complete atrioventricular block (CAVB) occurred. Catecholamine administration and ventricular pacing improved hemodynamics, and a self-expandable valve was implanted. CAVB resolved after surgery, but her state of consciousness was poor, and her left hand became ischemic. Imaging studies revealed multiple embolic infarcts in her bilateral cerebrum and cerebellum. Conclusions It should be noted that there is a risk of detachment of a calcified lesion of the aortic valve during TAVI, which can cause embolisms not only in the brain but also in the extremities and coronary arteries.

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Section: Discussionmentioning

confidence: 99%

Bilateral multiple stroke, left upper extremity ischemia, and transient complete atrioventricular block in transcatheter aortic valve implantation: a case report

Mitsuta,

Nakamura,

Uemura

et al. 2023

JA Clin Rep

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“…We utilize calcium score cutoffs of 2065 in males and 1275 in females for severe AS [22]. Recent studies have revealed that an elevated pre-TAVR calcium score from computed tomography is an independent risk factor for acute stroke, thus providing prognostication capabilities as well [23]. Computed tomography also provides the added benefit of a three-dimensional visualization of the valve and left ventricular outflow tract as two-dimensional imaging often results in underestimation of the severity of stenosis.…”

Section: Pre-procedural Work-upmentioning

confidence: 99%

“…The balloon-expandable SAPIEN 3 Ultra transcatheter aortic valve is the fifthgeneration valve in the Sapien series and is available in four sizes (20,23,26, and 29 mm). Its design consists of three bovine pericardial tissue leaflets with a cobalt-chromium frame.…”

Section: Sapien 3 Ultra (Edwards Lifesciences)mentioning

confidence: 99%

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Catheter-Based Therapies: Current Practices and Considerations

R. Shah,

Golzarian,

M. Patel

2024

Cardiology and Cardiovascular Medicine

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In just over a decade, there have been paradigm shifts globally in the catheter-based therapies available for the management of patients with severe aortic stenosis. The use of transcatheter aortic valve replacement (TAVR) has been a crucial turning point in the field of cardiology as it granted an option for a minimally invasive method to replace a valve for patients who may or may not be suitable for cardiac surgery. In this chapter, we discuss the current practices and considerations as well as the ongoing evolution of catheter-based approaches for TAVR. The predominant focus of the chapter will be on aortic valve device modifications, prototypes of valves, device delivery systems, and the various techniques. However, discussions on indications/contraindications, proper work-up, preparation, equipment and personnel, complications, and post-procedural management & surveillance will also be reviewed.

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“…AVCS is reported to be a useful prognostic imaging marker in AS and is associated with higher rates of mortality during follow-up, with a hazard ratio of 2.11 as a binary threshold[ 47 ]. In addition, a higher AVCS is reported to be an independent risk factor for acute stroke after transcatheter aortic valve replacement[ 48 ].…”

Section: Cardiac Ct For Diagnosis Of Specific Cardioembolic Sourcesmentioning

confidence: 99%

Evaluation of causal heart diseases in cardioembolic stroke by cardiac computed tomography

Yoshihara¹

2023

World J Radiol

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Cardioembolic stroke is a potentially devastating condition and tends to have a poor prognosis compared with other ischemic stroke subtypes. Therefore, it is important for proper therapeutic management to identify a cardiac source of embolism in stroke patients. Cardiac computed tomography (CCT) can detect the detailed visualization of various cardiac pathologies in the cardiac chambers, interatrial and interventricular septum, valves, and myocardium with few motion artifacts and few dead angles. Multiphase reconstruction images of the entire cardiac cycle make it possible to demonstrate cardiac structures in a dynamic manner. Consequently, CCT has the ability to provide high-quality information about causal heart disease in cardioembolic stroke. In addition, CCT can simultaneously evaluate obstructive coronary artery disease, which may be helpful in surgical planning in patients who need urgent surgery, such as cardiac tumors or infective endocarditis. This review will introduce the potential clinical applications of CCT in an ischemic stroke population, with a focus on diagnosing cardioembolic sources using CCT.

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Aortic Valve Calcium Score Is Associated With Acute Stroke in Transcatheter Aortic Valve Replacement Patients

Cited by 6 publications

References 34 publications

Bilateral multiple stroke, left upper extremity ischemia, and transient complete atrioventricular block in transcatheter aortic valve implantation: a case report

Bilateral multiple stroke, left upper extremity ischemia, and transient complete atrioventricular block in transcatheter aortic valve implantation: a case report

Catheter-Based Therapies: Current Practices and Considerations

Evaluation of causal heart diseases in cardioembolic stroke by cardiac computed tomography

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