The Impact of Aortic Arch Morphology on Periprocedural Stroke in Transcatheter Aortic Valve Replacement

<b>Objectives</b>: Stroke after transcatheter aortic valve replacement (TAVR) continues to be one of the most concerning complications. Anatomical variations of the aortic arch may increase the risk of embolic debris entering the brain during transfemoral catheter manipulation. We aimed to analyze the influence of aortic arch morphology on the occurrence of ischemic stroke during TAVR. <b>Methods</b>: We performed a retrospective, 1:2 propensity-matched case-control study to compare patients with and without periprocedural stroke (defined according to the Valve Academic Research Consortium III endpoints) after transfemoral TAVR between June 2007 and September 2022. Multi-slice computed tomography (MSCT) analysis of pre-TAVR aortograms was performed to investigate arch anatomy, configuration, curvature, and the take-off angles of the epi-aortic vessels. <b>Results</b>: A total of 2371 patients were enrolled in this study. Periprocedural ischemic stroke was observed in 67 patients. After propensity score matching, this study included 201 patients: 67 (case) vs. 134 (control). The mean age was 80.0 ± 13.2 and 81.6 ± 6.4 years (<i>p</i> = 0.5), and the mean Euroscore II was 4.1 ± 3.6 and 4.3 ± 41 (<i>p</i> = 0.7). There was no difference in arch anatomy (<i>p</i> = 0.2) and configuration (<i>p</i> = 0.8) between the groups. Arch curvature (<i>p</i> = 0.9) and angulation of the brachiocephalic (<i>p</i> = 0.3) and left common carotid artery (<i>p</i> = 0.058) also did not differ significantly between the case and control groups. <b>Conclusions</b>: MSCT analysis in this propensity score-matched study found no correlation between aortic arch geometry and TAVR-associated stroke.