title: Extracranial carotid artery stenosis and outcomes of patients undergoing transcatheter aortic valve replacement.
abstract: BACKGROUND
  Transcatheter aortic valve replacement (TAVR) is an alternative to open cardiac surgery in selected patients with severe aortic stenosis (AS). Carotid artery stenosis (CAS) has been associated with an increased risk of stroke following cardiac surgery, although the association between CAS and outcomes following TAVR is unclear. We therefore sought to study the prognostic impact of CAS on outcomes of patients undergoing TAVR.
  
  
  METHODS
  Consecutive patients (n=312) with severe symptomatic AS who underwent a carotid Doppler study immediately prior to TAVR were followed prospectively. Major adverse cardiovascular event (MACE) rates were stratified by the presence of CAS, defined in accordance with current practice guidelines.
  
  
  RESULTS
  Carotid atherosclerosis (CA, defined as any carotid plaque) was present in 301 (96.5%) of patients and CAS (peak systolic velocity [PSV]≥125cm/s; ≥50% diameter stenosis) in 97 (31.1%) patients. Severe CAS (PSV≥230cm/s; ≥70% stenosis, or near occlusion) was found in 20 (6.4%) patients. At long-term follow-up (248±205days), composite (20.9% vs. 19.6%, p=0.50) and individual (all-cause mortality, stroke, myocardial infarction, readmission for heart failure [19.5%% vs. 14.4%%, p=0.24; 3.3% vs. 2.1%, p=0.47; 1.4% vs. 0%, p=0.22; and 7.9% vs. 8.2%, p=0.84 respectively]) MACE rates did not differ significantly between patients without versus those with CAS. By multivariate analysis, CAS was not independently predictive of late MACE rates (HR=0.85, [95%CI 0.50-1.78], p=0.85).
  
  
  CONCLUSIONS
  CAS was not associated with worse outcomes following TAVR. The relative prognostic significance of CAS in patients considered for either surgical or transcatheter valve replacement merits further research.
authors.affiliation: Department of Cardiology, Tel-Aviv University, Tel Aviv, Israel; Tel-Aviv Medical Center, Tel-Aviv, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Ben-Shoshan
authors.affiliation: Department of Cardiology, Tel-Aviv University, Tel Aviv, Israel; Tel-Aviv Medical Center, Tel-Aviv, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Zahler
authors.affiliation: Department of Cardiology, Tel-Aviv University, Tel Aviv, Israel; Tel-Aviv Medical Center, Tel-Aviv, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Arie
authors.initials: A
authors.lastname: Steinvil
authors.affiliation: Department of Cardiology, Tel-Aviv University, Tel Aviv, Israel; Tel-Aviv Medical Center, Tel-Aviv, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Banai
authors.affiliation: Department of Cardiology, Tel-Aviv University, Tel Aviv, Israel; Tel-Aviv Medical Center, Tel-Aviv, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Keren
authors.affiliation: Department of Neurology, Tel-Aviv University, Tel Aviv, Israel; Tel-Aviv Medical Center, Tel-Aviv, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Natan M
authors.initials: NM
authors.lastname: Bornstein
authors.affiliation: Department of Cardiology, Tel-Aviv University, Tel Aviv, Israel; Tel-Aviv Medical Center, Tel-Aviv, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Finkelstein
authors.affiliation: Department of Cardiology, Tel-Aviv University, Tel Aviv, Israel; Tel-Aviv Medical Center, Tel-Aviv, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel. Electronic address: amirh@tlvmc.gov.il.
authors.forename: Amir
authors.initials: A
authors.lastname: Halkin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome
keywords: Aortic stenosis; Carotid artery stenosis; Transcatheter aortic valve replacement (TAVR)