title: Should We Perform Carotid Doppler Screening Before Surgical or Transcatheter Aortic Valve Replacement?
abstract: BACKGROUND
  Screening for internal carotid artery stenosis (ICAS) with Doppler ultrasound is commonly used before cardiovascular surgery. Nevertheless, the relationship between ICAS and procedure-related stroke in isolated aortic valve replacement is unclear.
  
  
  METHODS
  We retrospectively reviewed patients with artery stenosis who underwent ICAS screening before surgical (SAVR) or transcatheter aortic valve replacement (TAVR) between January 2007 and August 2014. Logistic regression models were used to determine the relation between post-procedure stroke and total (sum of left and right ICAS) and maximal unilateral ICAS. Age, sex, history of atrial fibrillation, cerebrovascular disease and diabetes, left ventricular ejection fraction, and procedure type were considered as covariates. Two-subgroup analyses were performed in patients who underwent TAVR and SAVR, adjusting for procedure specific details.
  
  
  RESULTS
  A total of 996 patients underwent ICAS screening before TAVR (n = 467) or SAVR (n = 529). The prevalence of at least ≥70% ICAS was 5.2% (n = 52) and incidence of 30-day stroke was 3.4% (n = 34). Eight patients who underwent carotid intervention before valve replacement and 6 patients with poor Doppler images were excluded from the final analysis. We found no statistically significant association between stroke and either the total or maximal unilateral ICAS for all patients (p = 0.13 and p = 0.39, respectively) or those undergoing TAVR (p = 0.27 and p = 0.63, respectively) or SAVR (p = 0.21 and p = 0.36, respectively).
  
  
  CONCLUSIONS
  We found no statistically significant association between ICAS severity procedure-related stroke after aortic valve replacement. This suggests that universal carotid Doppler screening before isolated TAVR or SAVR is unnecessary.
authors.affiliation: Division of Cardiology, Structural Heart and Valve Center, Atlanta, Georgia.
authors.forename: Jose F
authors.initials: JF
authors.lastname: Condado
authors.affiliation: Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Hanna A
authors.initials: HA
authors.lastname: Jensen
authors.affiliation: Division of Cardiology, Structural Heart and Valve Center, Atlanta, Georgia.
authors.forename: Aneel
authors.initials: A
authors.lastname: Maini
authors.affiliation: Department of Biostatistics and Bioinformatics, for Emory University Rollins School of Public Health, Atlanta, Georgia.
authors.forename: Yi-An
authors.initials: YA
authors.lastname: Ko
authors.affiliation: Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Rajaei
authors.affiliation: Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Lillian L
authors.initials: LL
authors.lastname: Tsai
authors.affiliation: Division of Cardiology, Structural Heart and Valve Center, Atlanta, Georgia.
authors.forename: Chandan
authors.initials: C
authors.lastname: Devireddy
authors.affiliation: Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Bradley
authors.initials: B
authors.lastname: Leshnower
authors.affiliation: Division of Cardiology, Structural Heart and Valve Center, Atlanta, Georgia.
authors.forename: Kreton
authors.initials: K
authors.lastname: Mavromatis
authors.affiliation: Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Sarin
authors.affiliation: Division of Cardiology, Structural Heart and Valve Center, Atlanta, Georgia.
authors.forename: James
authors.initials: J
authors.lastname: Stewart
authors.affiliation: Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Guyton
authors.affiliation: Division of Cardiology, Structural Heart and Valve Center, Atlanta, Georgia.
authors.forename: Vasilis
authors.initials: V
authors.lastname: Babaliaros
authors.affiliation: Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Chen
authors.affiliation: Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Michael
authors.initials: M
authors.lastname: Halkos
authors.affiliation: Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Amy
authors.initials: A
authors.lastname: Simone
authors.affiliation: Division of Cardiology, Structural Heart and Valve Center, Atlanta, Georgia.
authors.forename: Patricia
authors.initials: P
authors.lastname: Keegan
authors.affiliation: Division of Cardiology, Structural Heart and Valve Center, Atlanta, Georgia.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Block
authors.affiliation: Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia. Electronic address: vthoura@emory.edu.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D012039:Regional Blood Flow; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects; D018608:Ultrasonography, Doppler