Correlation and predictive factors of carotid artery stenosis and stroke after transcatheter aortic valve replacement: A multicenter retrospective study

BACKGROUND: Stroke is one of the severe complications following transcatheter aortic valve replacement (TAVR). However, the association between carotid artery stenosis (CAS) and post-TAVR stroke remains unclear. METHODS: Patients who received TAVR consecutively between July 2023 and December 2024 were enrolled. CAS was identified via preprocedural carotid Doppler ultrasonography. Hemodynamically significant CAS was specified as a ≥50% reduction in the carotid artery diameter relative to the distal segment. The principal endpoint was the incidence of acute ischemic stroke (AIS)/transient ischemic attack (TIA) during the 30-day follow-up after procedures. RESULTS: Overall, 595 patients (average age: 70.1 ± 6.9 years; 54.5% male) from three medical centers were included. CAS occurred in 22.5% of patients. During the 30-day follow-up after TAVR, the incidence of AIS/TIA was 2.2%. There were 14 all-cause deaths, with 9 cases attributed to stroke. The incidence of AIS/TIA showed a significantly higher level in patients with CAS compared to those non-CAS (6.0% vs. 1.1%, P < 0.001). CAS showed a significant correlation with a heightened risk of stroke over a 30-day period (adjusted odds ratio [aOR]: 2.39; 95% confidential interval [CI]: 1.88–3.19, P < 0.001) and death (aOR: 1.94; 95% CI: 1.67–2.32, P < 0.001). Potential confounders were adjusted for, yet this association persisted. CONCLUSIONS: CAS is common in patients undergoing TAVR, affecting over one-fifth of the population. CAS is significantly linked to a heightened risk of stroke or death within 30 days after TAVR.