Cardiovascular Revascularization Medicine最新文献

{"title":"Atrial fibrillation following patent foramen ovale closure: A large single-center institutional experience","authors":"Arsh Issany,&nbsp;Mohammad Alsheikh-Kassim,&nbsp;Aman Gupta,&nbsp;Vijay Iyer","doi":"10.1016/j.carrev.2025.10.003","DOIUrl":"10.1016/j.carrev.2025.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Patent foramen ovale (PFO) is a risk factor for stroke, and closure reduces this risk. However, atrial fibrillation (AF) occurs post-procedure in 3–7 % of cases.</div></div><div><h3>Objectives</h3><div>We aimed to (1) assess AF rates after PFO closure at our institution and (2) identify associated risk factors.</div></div><div><h3>Methods</h3><div>The records of 279 patients with no prior AF history who underwent PFO closure since 2019 were reviewed. Patients who developed AF were compared to a propensity matched control group of non-AF patients. The groups were assessed for occurrence of AF, comorbidities, echocardiographic parameters, and anticoagulation use. AF was reported from either loop recorder data, EKG, or emergency department or clinic documentation. Continuous variables (age, BMI, LA size, LAVI) were compared using <em>t</em>-tests; categorical variables (alcohol use, hypertension, hyperlipidemia, and diabetes) were assessed via odds ratios.</div></div><div><h3>Results</h3><div>AF developed in 35 patients (12.54 %), with an average onset of 100 days post-closure. Of these, 66 % were on anti-coagulation. AF patients had significantly higher alcohol use (OR = 6, <em>p</em>-value &lt;0.01), older age (<em>t</em> = 2.3, <em>p</em>-value &lt;0.03), and had a larger mean LAVI on echocardiography (<em>t</em> = 2.01, p-value &lt;0.05) compared to patients who did not develop AF.</div></div><div><h3>Conclusions</h3><div>The incidence of AF is higher at our hospital compared to other institutions. The occurrence of AF seems to be concentrated in the first 4 months after PFO closure. Alcohol and age were associated with an increased risk for the development of AF post PFO closure. A greater LAVI may correlate with increased risk of developing AF.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"88 ","pages":"Pages 5-8"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unmasking latent cardiac dysfunction in angina with non-obstructive coronary artery disease (ANOCA) patients: An advanced echocardiographic evaluation","authors":"Biniyam G. Demissei,&nbsp;Agostina A. Sanchez,&nbsp;Vaishnavi S. Sawant,&nbsp;Matteo Cellamare,&nbsp;Cheng Zhang,&nbsp;Sevket T. Ozturk,&nbsp;Vijoli Cermak,&nbsp;Beni R. Verma,&nbsp;Kalyan R. Chitturi,&nbsp;Ilan Merdler,&nbsp;Hayder Hashim,&nbsp;Brian C. Case,&nbsp;Federico M. Asch,&nbsp;Ron Waksman,&nbsp;Anita Sadeghpour","doi":"10.1016/j.carrev.2025.10.011","DOIUrl":"10.1016/j.carrev.2025.10.011","url":null,"abstract":"<div><h3>Background</h3><div>The pathophysiologic mechanisms underlying angina with non-obstructive coronary artery disease (ANOCA) are multifactorial, leading to myocardial injury and adverse cardiovascular events. The echocardiographic phenotyping of left ventricular function in patients with ANOCA is sparse.</div></div><div><h3>Methods</h3><div>Of the 362 patients enrolled in the Coronary Microvascular Disease Registry (CMDR), eighty-eight ANOCA patients with available transthoracic echocardiograms were included in this cross-sectional study, after excluding patients with poor image quality and those with LVEF ≤40 %. Artificial intelligence-assisted quantitative echocardiography analysis, with additional meticulous tracking inspection as necessary, was performed using the Us2.v2 platform. FDA-approved/cleared parameters of left ventricular deformation, wall thickness, and diastolic function were evaluated. Left atrial (LA) reservoir strain was quantified manually by an experienced echocardiographer.</div></div><div><h3>Results</h3><div>The mean age was 60 years (SD: 12), 72.7 % were female, and 65.5 % were Black. The mean LVEF was 60.4 % (SD: 6.5); 81.2 % of the patients had LVEF&gt;55 %. Global longitudinal strain (GLS) was abnormal, as defined by GLS &lt; 18 %, in 47.6 % of the patients. The majority (56 % to 70 %) had abnormal septal e’ velocity (&lt;7 cm/s), lateral e’ velocity (&lt;10 cm/s), and abnormal/borderline E/e’ (≥8). LA reservoir strain was abnormal (&lt;39 %) in 60 % of the patients. The proportion of patients with peak tricuspid regurgitation velocity &gt; 2.8 m/s and LA volume index &gt;34 mL/m², suggesting significant diastolic impairment, was 10.4 % and 7.9 %. Abnormal interventricular septum and posterior wall diameters (&gt;1.1 cm) were observed in 32.9 % and 23.5 %, respectively.</div></div><div><h3>Conclusion</h3><div>Our findings demonstrate a high prevalence of cardiac abnormalities, utilizing echocardiographic myocardial deformation parameters in patients with ANOCA.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"88 ","pages":"Pages 18-24"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145402473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of the Agatston score in the target vessel for predicting clinical outcomes in highly calcified coronary artery lesions","authors":"Satoshi Asada,&nbsp;Tomohiro Kawasaki,&nbsp;Sora Serikawa,&nbsp;Takashi Yamamoto,&nbsp;Kensyo Abe,&nbsp;Masao Hidaka,&nbsp;Toshiya Soejima,&nbsp;Yurie Fukami,&nbsp;Kazuki Haraguchi,&nbsp;Keisuke Hirai,&nbsp;Ryota Fukuoka,&nbsp;Yoshiya Orita,&nbsp;Kyoko Umeji,&nbsp;Hisashi Koga,&nbsp;Hiroshige Yamabe","doi":"10.1016/j.carrev.2025.10.009","DOIUrl":"10.1016/j.carrev.2025.10.009","url":null,"abstract":"<div><h3>Background</h3><div>While a high Agatston score in patients with highly calcified lesions undergoing elective percutaneous coronary intervention (PCI) may be associated with clinical outcomes, the specific impact of the Agatston score, particularly when measured in the target vessel, on PCI outcomes remains unclear. This study aimed to investigate the value of the Agatston score in the target vessel for the prediction of clinical outcomes in patients with highly calcified coronary artery lesions undergoing PCI with atherectomy.</div></div><div><h3>Methods</h3><div>A total of 345 patients who underwent elective PCI with atherectomy were classified into two groups on the basis of the quartiles of the Agatston score, as measured by coronary computed tomography angiography (CCTA) prior to the procedure: the low-to-intermediate Agatston score group (Q1-Q3: <em>n</em> = 107) and the high Agatston score group (Q4: <em>n</em> = 36). Event-free survival curves were generated using the Kaplan-Meier method, and statistical differences were assessed using the log-rank test. Additionally, multivariate Cox hazard analysis was performed to examine the association between a high Agatston score and major adverse cardiac events (MACE).</div></div><div><h3>Results</h3><div>In the multivariate Cox hazard analysis, a high Agatston score was significantly associated with MACE (HR 2.073, 95 % CI 1.055–4.074, <em>P</em> = 0.034) after adjusting for potential confounders.</div></div><div><h3>Conclusions</h3><div>A high Agatston score was significantly associated with mid- to long-term clinical outcomes. The Agatston score of the target vessel, as assessed by CCTA prior to the procedure, may serve as a prognostic marker for mid- to long-term outcomes in patients undergoing elective PCI with atherectomy.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"88 ","pages":"Pages 9-15"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145373016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Ascending aortic dilation in SCAD: Signal, substrate, or both?","authors":"Olga Toleva","doi":"10.1016/j.carrev.2026.04.004","DOIUrl":"10.1016/j.carrev.2026.04.004","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"88 ","pages":"Pages 33-34"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipoprotein(a) testing in invasive coronary angiography: Screening yield and anatomic coronary disease burden.","authors":"Ivana Jurin, Marin Pavlov, Šime Manola, Tomislava Bodrožić Džakić Poljak, Tomislav Krčmar, Igor Rudež, Irzal Hadžibegović","doi":"10.1016/j.carrev.2026.06.018","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.06.018","url":null,"abstract":"<p><strong>Background: </strong>Lipoprotein(a) [Lp(a)] is an inherited lipid-related risk factor that may be overlooked in invasive coronary practice. We assessed the yield of Lp(a) testing in patients undergoing coronary angiography and its association with anatomic coronary disease burden.</p><p><strong>Methods: </strong>We performed a retrospective registry analysis of consecutive patients undergoing invasive coronary angiography between 15 June 2024 and 1 January 2026. Patients with available Lp(a) measurement were included. We assessed clinically relevant Lp(a) thresholds, reconstructed phase 3 trial-like frameworks for emerging Lp(a)-lowering therapies, and evaluated the association between Lp(a) ≥149 nmol/L and an anatomic complex coronary artery disease endpoint defined as SYNTAX score ≥23, chronic total occlusion, or left main disease. Index revascularization was excluded from this composite.</p><p><strong>Results: </strong>Among 2379 unique patients, 2230 had available Lp(a) measurement. Men accounted for 1508 (67.6%) and women for 722 (32.4%). The cohort was overwhelmingly White European, although race/ethnicity was not systematically recorded and exact proportions were unavailable. Lp(a) was ≥125, ≥149, ≥175 and ≥200 nmol/L in 473 (21.2%), 413 (18.5%), 330 (14.8%) and 255 (11.4%) patients, respectively. After conservative renal exclusion, 264 patients (11.8%) remained potential candidates for at least one major phase 3 trial-like framework. Lp(a) ≥149 nmol/L was associated with anatomic complex CAD (adjusted odds ratio 1.50, 95% confidence interval 1.16-1.94; p = 0.002).</p><p><strong>Conclusions: </strong>In this male-predominant registry, Lp(a) elevation was common and identified a subgroup with trial-like screening relevance and greater anatomic CAD burden. Cross-sectional findings do not establish improved management or outcomes; generalizability by sex, age and ancestry requires prospective validation.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An assessment of the accuracy of a novel peripheral artery disease scoring system to identify obstructive coronary artery disease in patients with severe aortic stenosis.","authors":"Harsh V Thakkar, George Besis, Liam McCormick, Robert Gooley, Derek Chew, Michael Michail, Nitesh Nerlekar, Brian Ko, Adam J Brown","doi":"10.1016/j.carrev.2026.06.017","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.06.017","url":null,"abstract":"<p><strong>Background and aims: </strong>Peripheral arterial disease (PAD) and coronary artery disease (CAD) are both clinical manifestations of atherosclerosis, sharing pathobiological features with aortic stenosis (AS). Pre-transcatheter aortic valve replacement (TAVR) planning routinely includes CT assessment of aorto-iliac and common femoral arterial disease. The aim was to assess the feasibility and accuracy of a novel PAD scoring system (Hostile score) to exclude obstructive CAD pre-TAVR.</p><p><strong>Methods: </strong>Peripheral CTs of patients pre-TAVR, between 2019 and 2023, were retrospectively analysed and Hostile score calculated (low score ≤ 8.5, high score > 8.5). Obstructive CAD was defined as diameter stenosis ≥50% on invasive angiography. Feasibility and reproducibility of Hostile score was assessed. ROC analysis was performed to assess the accuracy of Hostile score to exclude obstructive CAD.</p><p><strong>Results: </strong>350 patients included (age 82 ± 7.2 yrs); 78% hypertension; 29% diabetes, 59% CKD and obstructive CAD present in 32.6%. Median Hostile score was 5 (IQR 2-8.9) with a median analysis time of 2.14 min (IQR 1.68-4.40). There was excellent intra-observer correlation (r = 0.91, 95%CI 0.84, 0.96) and a good interobserver correlation (r = 0.84, 95% CI 0.72, 0.91). Sensitivity, specificity, positive and negative predictive value of Hostile score to exclude obstructive CAD was 91.1%, 58.8%, 82.1% and 76.1%, respectively, with a diagnostic accuracy of 80.6% (AUC 0.82). Patients with high Hostile score had increased risk of all-cause mortality (OR 2.13, 95%CI 1.13, 4.02, p = 0.02).</p><p><strong>Conclusion: </strong>Hostile score has a high sensitivity and accuracy for excluding obstructive CAD in patients with severe AS and was associated with a higher all-cause mortality. Incorporating Hostile score as a screening tool on TAVR-CT may potentially reduce the requirement for invasive angiography.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eyeballing versus comprehensive geriatric frailty assessment and outcomes after transcatheter aortic valve replacement: Insights from a large cohort.","authors":"Ziad Arow, Juri Iwata, Akiko Masumoto, Antonella Millin, Amir Aker, Hana Vaknin-Assa, Abid Assali, Chiara De Biase, Nicolas Dumonteil, Didier Tchetche","doi":"10.1016/j.carrev.2026.06.016","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.06.016","url":null,"abstract":"<p><strong>Background: </strong>Frailty is common among TAVR candidates. While guidelines recommend formal geriatric assessment for risk stratification, frailty is often evaluated in daily practice using physician judgment - \"eyeball test\". This study compared outcomes of frail versus non-frail patients undergoing TAVR using frailty classification based on eyeballing or formal geriatric assessment.</p><p><strong>Methods: </strong>This study included all patients undergoing TAVR for severe aortic stenosis (AS) with balloon-expandable or self-expandable valves between 2012 and 2024. Frailty was assessed in two cohorts: by physician clinical judgment (the \"eyeball\" cohort) or by formal comprehensive geriatric assessment, which was reserved for cases deemed uncertain by the treating clinician. The primary endpoint was 1-year all-cause mortality.</p><p><strong>Results: </strong>A total of 6343 patients were included in the study. Frailty was assessed by eyeballing in 4603 patients and by comprehensive geriatric assessment in 1740 patients. In the eyeball assessment cohort, frail patients exhibited significantly higher rates of in-hospital mortality (2.1% vs. 1.0%, p = 0.006) and 1-year mortality (8.1% vs. 6.3%, p = 0.024). In the formal geriatric assessment cohort, frail patients demonstrated a numerically higher 1-year mortality rate compared with non-frail patients (7.3% vs. 5.3%); however, this difference did not reach statistical significance (p = 0.160). In both cohorts, there were no significant differences in the composite safety endpoint, PPM implantation, or moderate or greater PVL.</p><p><strong>Conclusion: </strong>Frailty assessed by routine clinical \"eyeballing\" provided prognostic stratification after TAVR. A pragmatic two-step strategy - routine eyeballing with comprehensive geriatric assessment reserved for uncertain cases, may represent an efficient approach for frailty evaluation in contemporary TAVR practice.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-enhanced ECG for acute coronary syndrome triage: A state-of-the-art review.","authors":"Keshav Garg, Vidhi Bhanushali, Nitesh Gautam, Khalid Sawalha, Aakash Rana, Ankit Agrawal, Robert F Spraggins, Landon Bruich, Buthainah Alhwarat, Murad Almasri, Jorge F Saucedo, Ahmed AbuHalimeh, Bhupendar Tayal, Faisal Rahman, Subhi J Al'Aref","doi":"10.1016/j.carrev.2026.06.015","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.06.015","url":null,"abstract":"<p><p>Acute coronary syndrome (ACS) remains a leading cause of emergency department presentations, yet triage based on the ST-elevation myocardial infarction (STEMI)/non-ST-elevation myocardial infarction (NSTEMI) paradigm misses approximately 25-34% of acute coronary occlusion myocardial infarction (OMI). Early artificial intelligence-electrocardiography (AI-ECG) models showed retrospective promise for detecting ischemic ECG patterns but lacked prospective validation. This review synthesizes emerging multicenter registry, prospective cohort, and pathway trial evidence for AI-ECG in ACS triage, including the Queen of Hearts registry, ROMIAE, and DIFOCCULT-3 studies. It is essential to distinguish two separate clinical tasks: (1) detecting OMI for emergent catheterization laboratory activation, and (2) ruling out acute myocardial infarction (MI), which requires serial high-sensitivity troponin and cannot be achieved by ECG alone. Contemporary findings suggest AI-ECG significantly improves OMI detection sensitivity (92% vs. 71% for standard care) and reduces false-positive catheterization laboratory activations by up to 91% among biomarker-negative patients. For acute MI rule-out, AI-ECG shows promise as an adjunct to troponin-based strategies, with a negative predictive value of approximately 99% when combined with high-sensitivity troponin and clinical risk scores. We propose a 'Second Opinion' framework in which AI augments physician judgment as a clinical decision support tool. Key implementation challenges include algorithmic bias, alert fatigue, documentation, and the risk of widening the digital divide. AI-ECG represents a shift toward a physiologically driven OMI vs. non-occlusive myocardial infarction (NOMI) diagnostic framework.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-based differences in long-term mortality after TAVR among patients with bicuspid aortic valve.","authors":"Xena Moore, Ken Chan, Siu-Chun M Ho, Sukhdeep Basra, Richard Smalling, Biswajit Kar, Abhijeet Dhoble","doi":"10.1016/j.carrev.2026.06.012","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.06.012","url":null,"abstract":"<p><strong>Background: </strong>Sex-related disparities after transcatheter aortic valve replacement (TAVR) have been described in tricuspid aortic stenosis, but long-term data in bicuspid aortic valve (BAV) stenosis remain limited.</p><p><strong>Aims: </strong>To evaluate sex-based differences in long-term mortality and predictors of outcomes after TAVR in patients with BAV stenosis.</p><p><strong>Methods: </strong>We retrospectively analyzed 327 patients with BAV stenosis (183 men, 144 women) who underwent TAVR from 2014 to 2025. Baseline, anatomic, procedural, and clinical outcomes were compared by sex. Cox models evaluated predictors of all-cause mortality and exploratory sex interactions.</p><p><strong>Results: </strong>Over a median follow-up of 4.5 years by reverse Kaplan-Meier analysis, 93 deaths occurred (57 men, 36 women). Men had more coronary artery disease and greater aortic valve calcium burden than women (median 3519 vs 1815 AU; p < 0.001). Long-term mortality did not differ significantly by sex, although a nonsignificant late trend toward worse survival was observed in men (31.1% vs 25.0%; log-rank p = 0.095). Older age independently predicted mortality, while higher STS score and prior CABG demonstrated borderline associations. Exploratory interaction analyses identified sex interactions for eGFR (HR 0.965, 95% CI 0.944-0.987; p = 0.002) and diabetes (HR 0.217, 95% CI 0.076-0.620; p = 0.004). Higher eGFR was associated with lower mortality among women, whereas diabetes was associated with mortality among men.</p><p><strong>Conclusions: </strong>Long-term mortality after TAVR for BAV stenosis did not differ significantly by sex. Exploratory findings suggest selected clinical comorbidities may be more informative than the anatomic parameters evaluated in this cohort.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between aortic wall thrombus and stroke among patients undergoing transfemoral aortic valve replacement.","authors":"Jason Galo, Abdullah Al-Qaraghuli, Dan Haberman, Nihar Jena, Waiel Abusnina, Matteo Cellamare, Michelle Offit, Cheng Zhang, Beni Verma, Pablo M Rubio, Itsik Ben-Dor, Ron Waksman, Toby Rogers","doi":"10.1016/j.carrev.2026.06.011","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.06.011","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}