title: Carotid artery disease and periprocedural stroke risk after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  To examine the role of carotid stenosis (CS) and other independent risk factors of perioperative stroke, following transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  Using data from the National Inpatient Sample database for analysis, patients who underwent TAVI were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Various preoperative and perioperative risk factors and their association with perioperative strokes were studied.
  
  
  RESULTS
  Data on 7566 patients who underwent a TAVI procedure from 2012 to 2013 were extracted. The average age of the patient population was 81.2 ± 0.32 years. The overall perioperative stroke rate in our patient cohort was 2.79%. Majority (94.6%) of the strokes were ischemic. Multivariate analysis showed the following independent risk factors for perioperative strokes after TAVI: female gender odds ratio (OR) = 2.25 (95% confidence interval [CI], 1.42-3.57), higher van Walraven score OR = 6.6 (95% CI = 3.71-11.73), bilateral CS OR = 4.46 (95% CI = 2.03-9.82), and TAVI with a cardiac procedure done under cardiopulmonary bypass OR = 2.84 (95% CI = 1.57-5.14).
  
  
  CONCLUSIONS
  Bilateral carotid disease is a significant risk factor for perioperative strokes following TAVI. Preoperative screening with carotid Doppler to identify high-risk patients appears to be warranted. In addition, patients of female gender were found to have an increased risk for carotid disease.
authors.affiliation: Department of Neurological Surgery and Neurology; Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Parthasarathy D
authors.initials: PD
authors.lastname: Thirumala
authors.affiliation: Harvard College, Boston, MA, USA.
authors.forename: Sruthi
authors.initials: S
authors.lastname: Muluk
authors.affiliation: Department of Neurological Surgery and Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Reshmi
authors.initials: R
authors.lastname: Udesh
authors.affiliation: Department of Neurological Surgery and Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Amol
authors.initials: A
authors.lastname: Mehta
authors.affiliation: Department of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Schindler
authors.affiliation: Department of Cardiology, University of Pittsburgh; Department of Cardiology, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
authors.forename: Suresh
authors.initials: S
authors.lastname: Mulukutla
authors.affiliation: Department of Cardiothoracic Surgery, Saints Heart and Vascular Institute, St. Anthony Hospital, Oklahoma City, USA.
authors.forename: Vinodh
authors.initials: V
authors.lastname: Jeevanantham
authors.affiliation: Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Wechsler
authors.affiliation: Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gleason
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000453:epidemiology; D002340:Carotid Artery Diseases / Q000453:epidemiology; D016893:Carotid Stenosis / Q000453:epidemiology*; D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology*; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*