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Abstract Details

Radiologic Characteristic Of Perioperative Large Vessel Occlusions In Patients Who Underwent Transcatheter And Surgical Valve Replacement
Cerebrovascular Disease and Interventional Neurology
P2 - Poster Session 2 (8:00 AM-9:00 AM)
4-003

We compared radiographic characteristics of large vessel occlusions (LVO)  following transcatheter and surgical aortic valve replacement (TAVR and SAVR) to LVOs of spontaneous ischemic strokes.
Stroke is a known perioperative complication of both TAVR and SAVR. However the prevalence and imaging characteristic of LVOs in perioperative TAVR and SAVR ischemic strokes is unclear.
Between January 2012 and December 2017, 9069 patients underwent TAVR or SAVR at a tertiary center. Perioperative stroke was defined as a stroke that occurred within 14 days of surgery. LVOs were detected using CTA or MRA and defined as internal carotid, middle cerebral (M1 and M2), basilar, or posterior cerebral artery occlusions. The site of occlusion was matched to its location on non-contrast CT brain. Control was LVOs of cardio embolic or large artery atherosclerotic origin from a single-center stroke registry. Tissue density of occlusive clots was measured in Hounsfield Unit (HU). We compared clot densities of perioperative LVOs to control LVOS.

107 patients had a perioperative stroke during the study period and met inclusion criteria for analysis. Overall, LVO represented 16.8% (n=18) of perioperative ischemic strokes . Frequencies of LVOs were similar between TAVR (6/28, 21.4%) and SAVR (12/79, 21.4%, p=0.45). Occlusions involved ICA in 5 patients, M1 MCA in 8, M2 in 3, P1 PCA in 1, and basilar in 1.

Clots from perioperative LVOs were more dense than clots of LVOs from patients with known cardioembolism (median 53.5 HU in perioperative, 40 HU in cardioembolism, p<0.001), but were similar to LVOs due to large artery atherosclerosis (median 55.5 HU, p=0.57). Four perioperative LVOs were noted to be exceptionally dense (mean 226.8 HU, SD=59) and separated themselves from the others.
The heterogeneity of LVOs can be appreciated on CT brain because of differences in clot density. These differences may be helpful in determining stroke etiology.  
Authors/Disclosures
Lucy Zhang, MD (Inova)
PRESENTER 		Dr. Zhang has nothing to disclose.
Joshua Santucci, MD (Cleveland Clinic) Dr. Santucci has nothing to disclose.
Sam S. Handshoe (Norton Healthcare) Dr. Handshoe has nothing to disclose.
Bhageeradh Mulpur, MD (University of Miami/Jackson Memorial Hospital - Vascular Neurology) Dr. Mulpur has nothing to disclose.