Steinvil Arie, Leshem-Rubinow Eran, Abramowitz Yigal, Shacham Yacov, Arbel Yaron, Banai Shmuel, Bornstein Natan M, Finkelstein Ariel, Halkin Amir
Departments of Cardiology and Neurology, Tel-Aviv Medical Center, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Catheter Cardiovasc Interv. 2014 Nov 15;84(6):1007-12. doi: 10.1002/ccd.25585. Epub 2014 Jul 10.
Our aim was to analyze the prevalence and predictors of Carotid artery stenosis (CAS) in patients undergoing transcatheter aortic valve implantation (TAVI).
CAS is associated with the risk of periprocedural stroke in patients undergoing cardiac surgery. However, little is known about the prevalence of and clinical significance of CAS in the setting of TAVI.
Consecutive patients undergoing a carotid Doppler study the day before TAVI were followed prospectively. CAS was defined in accordance with current practice guidelines. Logistic regression models were used to identify independent correlates of CAS.
The study included 171 patients (age 82 ± 6, male gender 47%). Carotid atherosclerosis (CA, defined as any carotid plaque) was present in 164 (96%) of patients, and CAS (peak systolic velocity [PSV] ≥ 125 cm/sec; ≥50% diameter stenosis) in 57 (33%) patients. Severe CAS (PSV ≥ 230 cm/sec; ≥70% stenosis, or near occlusion) was found in 15 (9%) patients. By multivariate analysis, smoking and a higher Euroscore independently predicted the presence of CAS. Patients in the present TAVI cohort had a significantly higher prevalence of both unilateral and bilateral CAS ≥ 50% than those in a previously reported cohort (n = 494 patients, age ≥ 70) undergoing clinically driven coronary angiography (33% vs. 20%, OR = 1.9, P = 0.001; and, 13% vs. 6%, OR = 2.3, P = 0.003, respectively). CAS was not independently associated with 30-day mortality or stroke rates.
The prevalence of CAS in patients undergoing TAVI is high, exceeding that observed in patients undergoing catheterization for coronary indications. The impact of CAS on clinical outcomes following TAVI merits further research.
我们的目的是分析经导管主动脉瓣植入术（TAVI）患者中颈动脉狭窄（CAS）的患病率及预测因素。
CAS与心脏手术患者围手术期卒中风险相关。然而，对于TAVI背景下CAS的患病率及临床意义知之甚少。
对TAVI前一天接受颈动脉多普勒检查的连续患者进行前瞻性随访。CAS根据现行实践指南定义。采用逻辑回归模型确定CAS的独立相关因素。
该研究纳入了171例患者（年龄82±6岁，男性占47%）。164例（96%）患者存在颈动脉粥样硬化（CA，定义为任何颈动脉斑块），57例（33%）患者存在CAS（收缩期峰值流速[PSV]≥125 cm/秒；直径狭窄≥50%）。15例（9%）患者发现重度CAS（PSV≥230 cm/秒；狭窄≥70%，或近乎闭塞）。多因素分析显示，吸烟和较高的欧洲心脏手术风险评估系统（Euroscore）独立预测CAS的存在。与先前报道的接受临床驱动冠状动脉造影的队列（n = 494例患者，年龄≥70岁）相比，本TAVI队列中单侧和双侧CAS≥50%的患病率显著更高（分别为33% vs. 20%，OR = 1.9，P = 0.001；以及13% vs. 6%，OR = 2.3，P = 0.003）。CAS与30天死亡率或卒中发生率无独立相关性。
TAVI患者中CAS的患病率很高，超过了因冠状动脉适应证接受导管检查的患者。CAS对TAVI后临床结局的影响值得进一步研究。
