Association between aortic wall thrombus and stroke among patients undergoing transfemoral aortic valve replacement.

BACKGROUND

Stroke is a major adverse event following transfemoral transcatheter aortic valve replacement (TAVR), often attributed to embolization of debris from the aortic valve or aorta. This study evaluated the relationship between severe aortic wall thrombus (AWT) on pre-TAVR imaging and peri-procedural stroke in a single-center cohort.

METHODS

Patients with peri-procedural stroke after transfemoral TAVR (January 2013-December 2023) were compared with a randomly selected stroke-free control group. Severe AWT on baseline CT was assessed using a validated segmental scoring system. Associations with stroke were examined using Firth penalized logistic regression, with a pre-specified multivariable model adjusting for severe aortic root calcification, pre-TAVR albumin, recent heart failure, and valve type.

RESULTS

Fifty-six patients with peri-procedural stroke (mean age 82 ± 8.6 years) and 92 controls (mean age 79 ± 9.8 years) were included. Strokes occurred a median of 1.5 days (interquartile range, 0-4 days) following TAVR. Severe AWT was present in 21.4% of stroke patients versus 3.3% of controls, corresponding to a univariable odds ratio (OR) of 7.18 (95% CI 2.28-29.16, p < 0.001). In the multivariable Firth model, severe AWT remained independently associated with stroke (OR 8.98, 95% CI 2.01-49.55, p = 0.004). AWT most frequently involved the descending thoracic (43%) and abdominal aorta (54%), and less commonly the ascending aorta (9-16%).

CONCLUSION

Severe AWT on pre-TAVR CT was independently associated with peri-procedural stroke in this single-center analysis. Given the retrospective design and temporal differences between groups, these hypothesis-generating findings warrant prospective validation.