Heart Failure Phenotypes Impact Functional Outcomes After Carotid Artery Stenting

Background The influence of heart failure (HF) phenotype on neurologic recovery following carotid artery stenting (CAS) is not well established. This study aimed to compare post‐procedural outcomes between patients with HF with preserved ejection fraction (HFpEF) and those with reduced ejection fraction (HFrEF).MethodWe conducted a multicenter prospective cohort study of patients with heart failure who underwent CAS at 15 participating centers between 2023 and 2024. Patients were stratified by HF phenotype: HFpEF (EF ≥50%) and HFrEF (EF <40%). Key outcomes included the modified Rankin Scale (mRS) at discharge, 30 days, and 90 days, as well as the NIH Stroke Scale (NIHSS) at discharge. Results Of the 105 patients included, 73 had HFpEF and 32 had HFrEF. There was no difference in baseline demographics. HFrEF was associated with worse neurologic outcomes, including higher mRS scores at discharge (2.75 vs 1.89, p = 0.024), at 30 days (2.57 vs 1.46, p = 0.010), and at 90 days (2.20 vs 1.31, p = 0.043). NIHSS at discharge was also higher among HFrEF patients (3.55 vs 1.34, p = 0.022). Rates of procedural complications did not differ between groups.ConclusionHFrEF was associated with significantly worse short‐ and medium‐term functional outcomes compared to HFpEF. These findings suggest that HF phenotype may be an important determinant of neurologic recovery and should be considered in preprocedural risk assessment.