TY - JOUR
T1 - Vascular assessment for transcatheter aortic valve replacement
T2 - Intravascular ultrasound compared with computed tomography
AU - Essa, Essa
AU - Makki, Nader
AU - Bittenbender, Peter
AU - Capers, Quinn
AU - George, Barry
AU - Rushing, Gregory
AU - Crestanello, Juan
AU - Boudoulas, Konstantinos Dean
AU - Lilly, Scott M.
PY - 2016/12
Y1 - 2016/12
N2 - BACKGROUND: Assessment of the femoral and iliac arteries is essential prior to transcatheter aortic valve replacement (TAVR). It is critical for establishing candidacy for a femoral approach, and can help predict vascular complications. Although computed tomography angiography (CTA) is the standard imaging modality, it has limitations. OBJECTIVE: This study compared CTA with intravascular ultrasound (IVUS) in patients undergoing TAVR evaluation. METHODS: Fifteen patients undergoing pre-TAVR coronary angiography and hemodynamic assessment were recruited. Following coronary angiography, patients underwent distal aortography, bilateral iliac and femoral arteriography, and IVUS assessment. Vascular tortuosity, minimum lumen diameter, and cross-sectional area were obtained and the findings were compared with those obtained from CTA. RESULTS: Correlation between IVUS and CTA was strong for minimum luminal diameter (r≤0.62). Concordance was also strong between CTA and invasive iliofemoral angiography for assessment of tortuosity (r≤0.75). Utilizing Bland-Altman analysis, vessel diameters obtained by IVUS were consistently greater than those obtained by CTA. The angiography and IVUS strategy was associated with a lower overall mean contrast utilization (29 cc vs 100 cc; P<.001), reduced mean radiation exposure (527 mGy vs 998 mGy; P≤.045), and no significant difference in mean test duration (13.3 minutes vs 10 minutes; P≤.12). CONCLUSIONS: For femoral and iliac arterial assessment prior to TAVR, IVUS is a viable alternative to CTA with comparable accuracy, and the potential for less contrast use and less radiation exposure. IVUS is also a valuable adjunct to CTA in patients with borderline femoral access diameters or considerable CTA artifacts.
AB - BACKGROUND: Assessment of the femoral and iliac arteries is essential prior to transcatheter aortic valve replacement (TAVR). It is critical for establishing candidacy for a femoral approach, and can help predict vascular complications. Although computed tomography angiography (CTA) is the standard imaging modality, it has limitations. OBJECTIVE: This study compared CTA with intravascular ultrasound (IVUS) in patients undergoing TAVR evaluation. METHODS: Fifteen patients undergoing pre-TAVR coronary angiography and hemodynamic assessment were recruited. Following coronary angiography, patients underwent distal aortography, bilateral iliac and femoral arteriography, and IVUS assessment. Vascular tortuosity, minimum lumen diameter, and cross-sectional area were obtained and the findings were compared with those obtained from CTA. RESULTS: Correlation between IVUS and CTA was strong for minimum luminal diameter (r≤0.62). Concordance was also strong between CTA and invasive iliofemoral angiography for assessment of tortuosity (r≤0.75). Utilizing Bland-Altman analysis, vessel diameters obtained by IVUS were consistently greater than those obtained by CTA. The angiography and IVUS strategy was associated with a lower overall mean contrast utilization (29 cc vs 100 cc; P<.001), reduced mean radiation exposure (527 mGy vs 998 mGy; P≤.045), and no significant difference in mean test duration (13.3 minutes vs 10 minutes; P≤.12). CONCLUSIONS: For femoral and iliac arterial assessment prior to TAVR, IVUS is a viable alternative to CTA with comparable accuracy, and the potential for less contrast use and less radiation exposure. IVUS is also a valuable adjunct to CTA in patients with borderline femoral access diameters or considerable CTA artifacts.
KW - aortic valve replacement
KW - vascular complications
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M3 - Article
C2 - 27922808
AN - SCOPUS:85003015933
SN - 1042-3931
VL - 28
SP - E172-E178
JO - Journal of Invasive Cardiology
JF - Journal of Invasive Cardiology
IS - 12
ER -