Extracranial carotid artery stenosis and outcomes of patients undergoing transcatheter aortic valve replacement

Background Transcatheter aortic valve replacement (TAVR) is an alternative to open cardiac surgery in selected patients with severe aortic stenosis (AS). Carotid artery stenosis (CAS) has been associated with an increased risk of stroke following cardiac surgery, although the association between CAS and outcomes following TAVR is unclear. We therefore sought to study the prognostic impact of CAS on outcomes of patients undergoing TAVR. Methods Consecutive patients (n = 312) with severe symptomatic AS who underwent a carotid Doppler study immediately prior to TAVR were followed prospectively. Major adverse cardiovascular event (MACE) rates were stratified by the presence of CAS, defined in accordance with current practice guidelines. Results Carotid atherosclerosis (CA, defined as any carotid plaque) was present in 301 (96.5%) of patients and CAS (peak systolic velocity [PSV] ≥ 125 cm/s; ≥ 50% diameter stenosis) in 97 (31.1%) patients. Severe CAS (PSV ≥ 230 cm/s; ≥ 70% stenosis, or near occlusion) was found in 20 (6.4%) patients. At long-term follow-up (248 ± 205 days), composite (20.9% vs. 19.6%, p = 0.50) and individual (all-cause mortality, stroke, myocardial infarction, readmission for heart failure [19.5%% vs. 14.4%%, p = 0.24; 3.3% vs. 2.1%, p = 0.47; 1.4% vs. 0%, p = 0.22; and 7.9% vs. 8.2%, p = 0.84 respectively]) MACE rates did not differ significantly between patients without versus those with CAS. By multivariate analysis, CAS was not independently predictive of late MACE rates (HR = 0.85, [95%CI 0.50–1.78], p = 0.85). Conclusions CAS was not associated with worse outcomes following TAVR. The relative prognostic significance of CAS in patients considered for either surgical or transcatheter valve replacement merits further research.