Major clinical outcomes in patients with carotid artery stenosis undergoing transcatheter aortic valve replacement: an updated meta-analysis

Background Data on carotid artery stenosis (CAS) prevalence in patients undergoing transcatheter aortic valve implantation (TAVI) are limited. It remains unclear whether CAS serves as a predictor of worse outcomes following TAVI. Purpose The porpose of this systematic review and meta-analysis is to evaluate the impact of CAS on major clinical outcomes in this population. Methods A comprehensive literature search of three major databases (Pubmed, Cochrane and Embase) was conducted to identify relevant studies, comparing the outcomes of patients with and without CAS following TAVI. The primary endpoint was the 30-day incidence of Stroke or Transient Ischemic Attack (TIA) in patients with CAS>= 50% and CAS>= 70%. Secondary endpoints included in-hospital Stroke/TIA, 30-day mortality, in-hospital mortality, bleeding, myocardial infarction (MI), acute kidney injury (AKI), periprocedural vascular complications, and permanent pacemaker implantation (PPM). Statistical analysis included Risk Ratio (RR) with 95% confidence interval (CI) using the random-effects model (Mantel-Haenzel). Results A total of 13 studies, involving 126,660 patients, were included in the metanalysis. CAS ≥ 50% was associated with a 42% higher rate of 30day Stroke/TIA (RR: 1.42, 95% CI: 1.01, 2.01) while CAS ≥ 70% with a 61% higher rate (RR: 1.61, 95% CI: 1.10, 2.36). CAS comorbidity was also linked to increased risk for in-hospital stroke/TIA (RR: 1.81, 95% CI: 1.25, 2.60), 30day mortality (RR: 1.29, 95% CI: 1.13, 1.47), and 30day bleeding events (RR: 1.15, 95% CI: 1.08, 1.23). No differences were observed in the other secondary endpoints. Conclusions CAS was associated with a higher 30-day mortality, possibly driven by the higher incidence of Stroke/TIA and bleeding events following TAVI. Further studies are required to validate our results.outcomes