Carotid Disease and Stroke After Transcatheter Aortic Valve Replacement
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In this issue of Circulation: Cardiovascular Interventions, Kochar et al1 report important results from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Registry (stroke and cardiovascular outcomes in patients with carotid disease undergoing transcatheter aortic valve replacement [TAVR]) that demonstrate the lack of interaction between carotid disease and stroke risk ≤1 year after TAVR. Among 29 143 patients undergoing TAVR at 390 US centers between 2013 and 2015, there was no association between carotid disease (irrespective of severity) and risk-adjusted stroke and death at 30 days or 1 year. This report is clinically relevant because although stroke prevention remains a priority after TAVR, these results indicate that screening for carotid disease before TAVR, or patient selection on this basis, is expected to yield limited (if any) benefit.
See Article by Kochar et al
Carotid Disease Stroke Risk and Implications for TAVR
Patients with carotid artery disease have an increased incidence of stroke, further increasing with disease severity and symptomatic status. Historically, reported rates of stroke at 5 years among medically treated patients with moderate-to-severe carotid disease (≥50% diameter stenosis) are ≈7% to 10% in the absence of prior symptoms and 15% to 28% with prior ipsilateral stroke or transient ischemic attack.2 It is not known whether the presence of carotid disease, its severity, or symptomatic status affects stroke rates after TAVR. This question is clinically important because prospective identification of TAVR patients at elevated risk for postprocedure stroke (both acute and late) could guide patient selection or preventive measures.
TAVR Stroke Risk and Mechanism
The pathogenesis of stroke after TAVR can be broadly categorized into acute procedure-related stroke and longer-term patient- or prosthesis-related stroke.
Procedural Stroke Risk
Major stroke affects 3% to 7% of patients …