title: Carotid Artery Stenosis in the Setting of Transcatheter Aortic Valve Replacement: Clinical and Technical Considerations of Carotid Stenting.
abstract: OBJECTIVE
  No consensus exists regarding the safety and efficacy of treatment of carotid stenosis before transcatheter aortic valve replacement (TAVR). Our objective was to review our series of patients treated for carotid stenosis with stenting in the setting of severe aortic valve disease and TAVR to evaluate its safety and efficacy.
  
  
  METHODS
  We reviewed patients who underwent carotid stenting in the setting of preoperative work-up or after TAVR from August 2012 through January 2015. Perioperative patient outcomes were collected to assess the safety and efficacy of carotid stenting.
  
  
  RESULTS
  Five patients (4 men, 1 woman; median age, 83 years; range, 72-88 years) underwent successful carotid stenting before (median, 30 days before; range, 2 days-3 months) TAVR. The median extent of carotid stenosis was 80% (range, 75%-90%), but the diagnoses were incidental and all patients were asymptomatic. One patient suffered acute systolic heart failure during stenting requiring emergent balloon aortic valvuloplasty and vasopressor therapy. Median intensive care unit stay was 1 day (range, 1-16 days) for all patients, and 1 day for patients treated electively. The median hospital stay was 1 day (range, 1-16 days) for all patients, and 1 day for patients treated electively. All patients were discharged home. None suffered immediate or delayed neurological complications.
  
  
  CONCLUSIONS
  We successfully performed carotid stenting in 5 patients before TAVR for severe aortic pathology. These patients require intensive care and careful monitoring. Larger prospective studies are needed to determine whether carotid stenting in the setting of TAVR can provide long-term neurological benefits.
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Ravindra
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Mazur
authors.affiliation: Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Ganesh S
authors.initials: GS
authors.lastname: Kumpati
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Min S
authors.initials: MS
authors.lastname: Park
authors.affiliation: Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Amit N
authors.initials: AN
authors.lastname: Patel
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Anwar
authors.initials: A
authors.lastname: Tandar
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Frederick G
authors.initials: FG
authors.lastname: Welt
authors.affiliation: Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah, USA.
authors.forename: David
authors.initials: D
authors.lastname: Bull
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors.forename: William T
authors.initials: WT
authors.lastname: Couldwell
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA. Electronic address: neuropub@hsc.utah.edu.
authors.forename: Philipp
authors.initials: P
authors.lastname: Taussky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D018579:Patient Selection; D010865:Pilot Projects; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome
keywords: Aortic valve; Carotid artery stenosis; Carotid stenting; Monitored anesthesia care; Transcatheter; Valve replacement