Lack of Association Between Extracranial Carotid and Vertebral Artery Disease and Stroke After Transcatheter Aortic Valve Replacement

Chetan P. Huded, Quentin Riggins Youmans, Jyothy John Puthumana, Ranya Nabil Sweis, Mark J Ricciardi, S Chris Malaisrie, Charles J Davidson, James D Flaherty*

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1419-1424
Number of pages6
JournalCanadian Journal of Cardiology
Volume32
Issue number12
DOIs
StatePublished - Dec 1 2016

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Carotid Artery Diseases
Vertebral Artery
Stroke
Carotid Stenosis
Vertebrobasilar Insufficiency
Survival
Mortality
Peripheral Arterial Disease
Common Carotid Artery
Transcatheter Aortic Valve Replacement
Aortic Valve
Carotid Arteries
Surgical Instruments
Tertiary Care Centers
Coronary Artery Bypass
Coronary Artery Disease
Pathologic Constriction
Logistic Models
Control Groups

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{58bf562095154b08b9403b9596ef503f,
title = "Lack of Association Between Extracranial Carotid and Vertebral Artery Disease and Stroke After Transcatheter Aortic Valve Replacement",
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.",
author = "Huded, {Chetan P.} and Youmans, {Quentin Riggins} and Puthumana, {Jyothy John} and Sweis, {Ranya Nabil} and Ricciardi, {Mark J} and Malaisrie, {S Chris} and Davidson, {Charles J} and Flaherty, {James D}",
year = "2016",
month = "12",
day = "1",
doi = "10.1016/j.cjca.2016.03.010",
language = "English (US)",
volume = "32",
pages = "1419--1424",
journal = "Canadian Journal of Cardiology",
issn = "0828-282X",
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TY - JOUR

T1 - Lack of Association Between Extracranial Carotid and Vertebral Artery Disease and Stroke After Transcatheter Aortic Valve Replacement

AU - Huded, Chetan P.

AU - Youmans, Quentin Riggins

AU - Puthumana, Jyothy John

AU - Sweis, Ranya Nabil

AU - Ricciardi, Mark J

AU - Malaisrie, S Chris

AU - Davidson, Charles J

AU - Flaherty, James D

PY - 2016/12/1

Y1 - 2016/12/1

N2 - 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.

AB - 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.

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U2 - 10.1016/j.cjca.2016.03.010

DO - 10.1016/j.cjca.2016.03.010

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VL - 32

SP - 1419

EP - 1424

JO - Canadian Journal of Cardiology

JF - Canadian Journal of Cardiology

SN - 0828-282X

IS - 12

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