Preventive effects of temporary bilateral carotid artery compression on stroke during transcatheter aortic valve implantation

Objective To prevent stroke during transcatheter aortic valve implantation (TAVI), cerebral embolic protection devices have been temporarily deployed during the procedure. However, several reports have demonstrated that these devices have not significantly reduced the incidence of periprocedural stroke after TAVI. The use of protection devices during TAVI is considered complicated and costly. Thus, we performed a simple, non-invasive, and cost-effective procedure to prevent cerebral embolism during TAVI. We assessed the stroke prevention effects of this technique. Methods We compared all cases of TAVI performed at our hospital between February 2021 and January 2025 and retrospectively divided the cases into carotid compression and control groups. In the carotid compression group, both carotid arteries were temporarily compressed by an anesthesiologist only during balloon expansion of the aortic valve and during balloon-expandable device placement, releasing the compression upon completion of the expansion (Figure). The primary endpoint was the presence of disabling stroke during hospitalization after TAVI. The secondary endpoints were the rates of all complications after TAVI. Results A total of 204 TAVI cases were enrolled. Of these, 110 patients were in the carotid compression group and 94 were in the control group. The mean age was 86.4 ± 4.6 years in the carotid compression group and 85.9 ± 4.6 years in the control group. The mean NYHA class and the mean Society of Thoracic Surgeons scores between the two groups were 2.4 ± 0.7 vs. 2.7 ± 0.6 and 8.6 ± 6.1 vs. 8.5 ± 10.5, in the carotid compression and control groups, respectively. In the carotid compression group, the rates of porcelain aorta and mean Agatston score in the sinus of Valsalva were higher than in the control group (57 cases (52%) vs. 28 cases (30%) and 2,995 ± 1,725 vs. 1,998 ± 1,084; P < 0.05). Based on these data, it was suggested that the carotid compression group might have a higher stroke risk due to the anatomical structure of the aortic valve and aorta. The TAVI procedure was completed in all cases. Regarding the primary endpoint, the incidence of disabling stroke was lower in the carotid compression group than in the control group (carotid compression group: 2 cases (1.8%) vs. control group: 8 cases (8.5%); P < 0.05). Regarding the secondary endpoint, the incidence of all complications after TAVI was lower in the carotid compression group than in the control group (carotid compression group: 8 cases (7%) vs. control group: 17 cases (18%); P < 0.05). Conclusion Temporary bilateral carotid artery compression during TAVI reduced the incidence of disabling stroke. This result indicates that this non-invasive and cost-effective technique may be better for preventing cerebral embolisms.