BACKGROUND Thromboembolic events, particularly strokes, remain a major complication of transcatheter aortic valve replacement (TAVR). Embolic protection devices have failed to show significant clinical benefit in large randomized clinical trials. Aortic wall thrombus (AWT) is often observed on multidetector computed tomography during TAVR work-up, but its prognostic significance is uncertain. OBJECTIVES This study sought to evaluate the association between the presence of AWT and the incidence of thromboembolic outcomes in patients undergoing transfemoral (TF) TAVR for severe aortic stenosis. METHODS This was a prospective cohort study of consecutive patients who underwent TF TAVR for severe aortic stenosis between January 2011 and April 2022. A dedicated scale (range: 0-10) was qualitatively used to assess AWT. The primary outcome was a composite of procedural thromboembolic events defined as ischemic stroke, blue toe syndrome, bowel ischemia, or other solid organ infarction. The secondary endpoints were ischemic strokes and procedural death. RESULTS Of the 641 patients included, severe AWT (score ≥8) was identified in 73 (11.4%). The presence of severe AWT was strongly associated with an increase in the primary outcome (OR: 8.48; 95% CI: 3.36-21.40; P < 0.001). This relationship persisted following multivariable analysis, which adjusted for comorbidities and procedural characteristics. The presence of severe AWT was also found to be associated with an increased incidence of stroke and procedural death (OR: 5.66; 95% CI: 2.00-15.30; P = 0.002 and OR: 4.66; 95% CI: 1.80-11.30; P = 0.002, respectively). CONCLUSIONS The presence of severe AWT on preprocedural multidetector computed tomography is strongly associated with thromboembolic complications including stroke and mortality after TF TAVR.

中文翻译：

---

主动脉壁血栓与经股经导管主动脉瓣置换术后血栓栓塞事件之间的关联。


背景技术血栓栓塞事件，特别是中风，仍然是经导管主动脉瓣置换术(TAVR)的主要并发症。在大型随机临床试验中，栓塞防护装置未能显示出显着的临床益处。主动脉壁血栓（AWT）经常在 TAVR 检查期间通过多排计算机断层扫描观察到，但其预后意义尚不确定。目的 本研究旨在评估因严重主动脉瓣狭窄而接受经股动脉 (TF) TAVR 的患者中 AWT 的存在与血栓栓塞结局发生率之间的关系。方法 这是一项前瞻性队列研究，研究对象为 2011 年 1 月至 2022 年 4 月期间因严重主动脉瓣狭窄接受 TF TAVR 的连续患者。使用专用量表（范围：0-10）定性评估 AWT。主要结局是手术性血栓栓塞事件的复合，定义为缺血性中风、蓝趾综合征、肠缺血或其他实体器官梗塞。次要终点是缺血性中风和手术性死亡。结果 在纳入的 641 名患者中，73 名患者（11.4%）患有严重 AWT（评分≥8）。严重 AWT 的存在与主要结局的增加密切相关（OR：8.48；95% CI：3.36-21.40；P < 0.001）。经过多变量分析后，这种关系仍然存在，并根据合并症和手术特征进行了调整。还发现严重 AWT 的存在与中风和手术死亡发生率增加相关（OR：5.66；95% CI：2.00-15.30；P = 0.002 和 OR：4.66；95% CI：1.80-11.30；P = 0.002，分别）。 结论 术前多排计算机断层扫描显示严重 AWT 与 TF TAVR 后的血栓栓塞并发症（包括中风和死亡率）密切相关。