For transfemoral TAVR, contrast CT helps cut risk of vascular complications

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Sapien transcatheter aortic valve.
Source: Edwards Lifesciences

Imaging with contrast CT instead of angiography to assess vessel diameter may lead to fewer transfemoral approach sheath-related complications during transcatheter aortic valve replacement (TAVR), a study published in the January issue of Circulation: Cardiovascular Imaging found.

TAVR procedures included in the study were performed between 2007 and 2013. Patients had severe symptomatic aortic stenosis and TAVR was performed with a transfemoral approach. Researchers used cases where patients had either a contrast or noncontrast CT and an angiographic assessment.

Lead author Kazuaki Okuyama, MD, from the Heart Institute at Cedars-Sinai Medical Center in Los Angeles, and colleagues found that contrast angiography had a better ability to predict vessel size. But contrast CT had a better predictive value for vascular complications. Contrast CT patients’ area under the curve was 0.87 vs 0.72 for angiography. Noncontrast CT and angiography had no difference for area under the curve (0.79).

Of the 283 patients assessed with contrast CT, 67 cases experienced vascular complications. Of those 67 cases, 52 percent had sheath-related complications. Of 103 noncontrast CT patients, 28 vascular complications occurred with a 61 percent rate of sheath-related complications among them.

Okuyama et al noted that while single-plane angiography had greater resolution and more accurately assessed focal stenoses, it did not provide a 3D assessment. 3D assessment through contrast CT allowed for a better understanding of true vessel diameters. They did not find noncontrast CT as effective, however, and recommended considering low contrast CT or noncontrast CT in combination with angiography or intravascular ultrasound.