Tomsich Family Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Can J Cardiol. 2016 Dec;32(12):1419-1424. doi: 10.1016/j.cjca.2016.03.010. Epub 2016 Mar 29.
Carotid artery stenosis is a risk factor for stroke after surgical aortic valve replacement, but it is unknown whether carotid and vertebral artery disease impacts the risk of stroke after transcatheter aortic valve replacement (TAVR).
We reviewed 294 consecutive cases of TAVR at a tertiary care medical centre. Thirty-one patients without preoperative carotid/vertebral duplex ultrasonograms were excluded. Carotid or vertebral artery disease was defined on the basis of >50% stenosis. Outcomes were stroke within 30 days after TAVR, 30-day mortality, and overall survival.
Fifty-one patients (19%) had at least 50% stenosis of a carotid or vertebral artery. The carotid and vertebral artery disease group had higher rates of coronary artery disease, previous coronary artery bypass surgery, and peripheral artery disease compared with the control group. Transfemoral access was less common in the carotid and vertebral artery disease group (55% vs 77%; P < 0.01). Stroke occurred in 6.8% of patients (n = 18) within 30 days after TAVR, but no patients in the carotid and vertebral artery disease group had a stroke. The presence of at least 50% stenosis of a carotid or vertebral artery was not predictive of stroke by logistic regression. There was no difference in 30-day mortality (10% vs 4%; P = 0.11) and overall survival (log-rank test P = 0.84) between the groups.
The presence or absence of carotid or vertebral artery stenosis was not significantly related to the occurrence of stroke after TAVR. Routine screening for carotid and vertebral artery disease before TAVR does not appear justified.
颈动脉狭窄是主动脉瓣置换术后中风的一个危险因素，但尚不清楚颈动脉和椎动脉疾病是否会影响经导管主动脉瓣置换术（TAVR）后的中风风险。
我们回顾了一家三级护理医疗中心的 294 例连续 TAVR 病例。排除了 31 例没有术前颈动脉/椎动脉双重超声检查的患者。颈动脉或椎动脉疾病是基于 >50%狭窄来定义的。结果是 TAVR 后 30 天内的中风、30 天死亡率和总生存率。
51 例（19%）至少有一侧颈动脉或椎动脉狭窄 50%以上。与对照组相比，颈动脉和椎动脉疾病组的冠心病、既往冠状动脉旁路移植术和外周动脉疾病发生率更高。经股动脉入路在颈动脉和椎动脉疾病组中更为少见（55% vs 77%；P < 0.01）。TAVR 后 30 天内，有 6.8%的患者（n=18）发生中风，但颈动脉和椎动脉疾病组无患者发生中风。Logistic 回归分析显示，至少有一侧颈动脉或椎动脉狭窄 50%以上并不能预测中风的发生。两组之间 30 天死亡率（10% vs 4%；P=0.11）和总生存率（log-rank 检验 P=0.84）均无差异。
颈动脉或椎动脉狭窄的存在与否与 TAVR 后中风的发生无显著相关性。在 TAVR 前常规筛查颈动脉和椎动脉疾病似乎没有必要。
