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Association of Bovine Arch Anatomy With Incident Stroke After Transcatheter Aortic Valve Replacement
Gerardo V Lo Russo1, Hasan S Alarouri1, Abdulah Al-Abcha1
1Department of Cardiovascular Medicine Mayo Clinic Rochester MN.
Insights
A bovine arch anatomy increases the risk of stroke after transcatheter aortic valve replacement (TAVR). This finding highlights the importance of aortic arch morphology in TAVR stroke risk assessment.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Acute ischemic stroke is a known complication of transcatheter aortic valve replacement (TAVR), occurring in 2% to 3% of procedures.
- Identifying anatomical factors associated with stroke risk after TAVR is crucial for patient management.
Purpose of the Study:
- To investigate the association between aortic arch morphology, specifically a bovine arch, and the risk of periprocedural and long-term stroke following TAVR.
- To identify aortic anatomic correlates that may predispose patients to stroke after TAVR.
Main Methods:
- Retrospective analysis of 2775 patients undergoing TAVR at a single center from 2012 to 2022.
- Manual review of pre-TAVR computed tomography (CT) images to determine aortic arch morphology (bovine vs. non-bovine).
- Logistic regression for periprocedural stroke and Cox proportional hazards regression for long-term stroke, adjusting for covariates.
Main Results:
- A bovine arch morphology was present in 17.8% of patients.
- The incidence of periprocedural stroke was significantly higher in patients with a bovine arch (3.6% vs. 1.7%, P=0.01).
- A bovine arch was independently associated with increased periprocedural (aOR, 2.16) and long-term stroke risk (aHR, 2.11) after TAVR.
Conclusions:
- Bovine arch anatomy is a significant independent predictor of both periprocedural and long-term stroke after TAVR.
- This anatomical variation should be considered in the risk stratification and management of patients undergoing TAVR.
Background:
Acute ischemic stroke complicates 2% to 3% of transcatheter aortic valve replacements (TAVRs). This study aimed to identify the aortic anatomic correlates in patients after TAVR stroke.
Methods And Results:
This is a single-center, retrospective study of patients who underwent TAVR at the Mayo Clinic between 2012 and 2022. The aortic arch morphology was determined via a manual review of the pre-TAVR computed tomography images. An "a priori" approach was used to select the covariates for the following: (1) the logistic regression model assessing the association between a bovine arch and periprocedural stroke (defined as stroke within 7 days after TAVR); and (2) the Cox proportional hazards regression model assessing the association between a bovine arch and long-term stroke after TAVR. A total of 2775 patients were included (59.6% men; 97.8% White race; mean±SD age, 79.3±8.4 years), of whom 495 (17.8%) had a bovine arch morphology. Fifty-seven patients (1.7%) experienced a periprocedural stroke. The incidence of acute stroke was significantly higher among patients with a bovine arch compared with those with a nonbovine arch (3.6% versus 1.7%; P=0.01). After adjustment, a bovine arch was independently associated with increased periprocedural strokes (adjusted odds ratio, 2.16 [95% CI, 1.22-3.83]). At a median follow-up of 2.7 years, the overall incidence of post-TAVR stroke was 6.0% and was significantly higher in patients with a bovine arch even after adjusting for potential confounders (10.5% versus 5.0%; adjusted hazard ratio, 2.11 [95% CI, 1.51-2.93]; P<0.001).
Conclusions:
A bovine arch anatomy is associated with a significantly higher risk of periprocedural and long-term stroke after TAVR.
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