title: Lack of Association Between Extracranial Carotid and Vertebral Artery Disease and Stroke After Transcatheter Aortic Valve Replacement.
abstract: 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).
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Tomsich Family Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Chetan P
authors.initials: CP
authors.lastname: Huded
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Quentin R
authors.initials: QR
authors.lastname: Youmans
authors.affiliation: Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Jyothy J
authors.initials: JJ
authors.lastname: Puthumana
authors.affiliation: Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Ranya N
authors.initials: RN
authors.lastname: Sweis
authors.affiliation: Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Ricciardi
authors.affiliation: Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Sukit Chris
authors.initials: SC
authors.lastname: Malaisrie
authors.affiliation: Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Davidson
authors.affiliation: Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. Electronic address: jflahert@nm.org.
authors.forename: James D
authors.initials: JD
authors.lastname: Flaherty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D016019:Survival Analysis; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods; D014481:United States; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000000981:diagnostic imaging