Aortic Stenosis affects over 5% of the population over 65. 

Even though TAVR has advanced in the treatment of this disease, many patients present carotid aortic stenosis (CAS), which involves additional surgical risk. This risk has not been thoroughly assessed in the context of TAVR. 

A meta-analysis was carried out including 5 observational studies with a total 111,915 patients. Mean patient age was 83 and 46% were women.

Stroke or transient ischemic attack (TIA) rate was higher in patients presenting CAS (OR 1.44; CI 95% 1.07–1.95; p = 0.016), with no significant differences in myocardial infarction (OR 1.24; CI 95% 1.05–1.47; p = 0.074), all-cause mortality (OR 0.99; CI 95% 0.71–1.37; p = 0.94), acute kidney failure (OR 0.98; CI 95% 0.90–1.06) and the need for pacemaker implantation after TAVR (OR 0.95; CI 95% 0.70–1.30; p = 0.759) between both groups.

Conclusión

This analysis revealed a link between carotid stenosis and cerebrovascular events in patients undergoing TAVR, with no significant impact on all-cause mortality. We highlight the need for prospective studies for a more detailed assessment of additional determinants of this association, such as unilateral or bilateral compromise and stenosis degree, which increases risk. 

Original Title: Impact of carotid artery stenosis on outcomes of transcatheter aortic valve replacement: A systematic review and meta-analysis.

Reference: Lucas Caetano da Silva, et al. International Journal of Cardiology, https://doi.org/10.1016/j.ijcard.2023.131670.

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