Abstract
Background
Carotid artery stenosis is a risk factor for stroke after surgical aortic valve replacement,
but it is unknown whether carotid and vertebral artery disease impacts the risk of
stroke after transcatheter aortic valve replacement (TAVR).
Methods
We reviewed 294 consecutive cases of TAVR at a tertiary care medical centre. Thirty-one
patients without preoperative carotid/vertebral duplex ultrasonograms were excluded.
Carotid or vertebral artery disease was defined on the basis of >50% stenosis. Outcomes
were stroke within 30 days after TAVR, 30-day mortality, and overall survival.
Results
Fifty-one patients (19%) had at least 50% stenosis of a carotid or vertebral artery.
The carotid and vertebral artery disease group had higher rates of coronary artery
disease, previous coronary artery bypass surgery, and peripheral artery disease compared
with the control group. Transfemoral access was less common in the carotid and vertebral
artery disease group (55% vs 77%; P < 0.01). Stroke occurred in 6.8% of patients (n = 18) within 30 days after TAVR,
but no patients in the carotid and vertebral artery disease group had a stroke. The
presence of at least 50% stenosis of a carotid or vertebral artery was not predictive
of stroke by logistic regression. There was no difference in 30-day mortality (10%
vs 4%; P = 0.11) and overall survival (log-rank test P = 0.84) between the groups.
Conclusions
The presence or absence of carotid or vertebral artery stenosis was not significantly
related to the occurrence of stroke after TAVR. Routine screening for carotid and
vertebral artery disease before TAVR does not appear justified.
Résumé
Introduction
La sténose carotidienne est un facteur de risque d’accident vasculaire cérébral (AVC)
après le remplacement chirurgical de la valvule aortique, mais on ignore si l’atteinte
de l’artère carotide et de l’artère vertébrale a une incidence sur le risque d’AVC
après le remplacement valvulaire aortique par cathéter (RVAC).
Méthodes
Nous avons passé en revue 294 cas consécutifs de RVAC d’un centre médical de soins
tertiaires. Trente et un patients n’ayant pas subi d’échographie en mode duplex des
artères carotides et vertébrales avant la chirurgie ont été exclus. L’atteinte de
l’artère carotide et de l’artère vertébrale a été définie en fonction d’une sténose
>50 %. Les résultats étaient l’AVC dans les 30 jours après le RVAC, la mortalité à
30 jours et la survie globale.
Résultats
Cinquante et un patients (19 %) avaient au moins une sténose de l’artère carotide
ou de l’artère vertébrale de 50 %. Le groupe ayant une atteinte de l’artère carotide
et de l’artère vertébrale montrait des taux plus élevés de maladies coronariennes,
de pontages coronariens antérieurs et de maladies artérielles périphériques que le
groupe témoin. La voie transfémorale était moins fréquente dans le groupe ayant une
atteinte de l’artère carotide et de l’artère vertébrale (55 % vs 77 %; P < 0,01). L’AVC survenait chez 6,8 % des patients (n = 18) dans les 30 jours après
le RVAC, mais aucun patient du groupe atteint d’une sténose de l’artère carotide et
de l’artère vertébrale ne subissait d’AVC. La régression logistique démontrait que
la présence d’une atteinte de l’artère carotide et de l’artère vertébrale d’au moins
50 % ne constituait pas un prédicteur de l’AVC. Il n’existait aucune différence de
la mortalité à 30 jours (10 % vs 4 %; P = 0,11) et de la survie globale (test logarithmique par rangs P = 0,84) entre les groupes.
Conclusions
La présence ou l’absence de sténose de l’artère carotide ou de l’artère vertébrale
n’était pas significativement associée à la survenue de l’AVC après le RVAC. Le dépistage
systématique de l’atteinte de l’artère carotide et de l’artère vertébrale avant le
RVAC ne semble pas justifié.
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Article info
Publication history
Published online: March 29, 2016
Accepted:
March 16,
2016
Received:
March 7,
2016
Footnotes
See page 1423 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
