Oestreicher Simon, Vella Agnese, Muller Olivier, Kirsch Matthias, Eeckhout Eric, Fournier Stephane, Monney Pierre, Roux Olivier, Roguelov Christan, Zhang Philippe, Abraham Paul, Ferlay Clémence, Antiochos Panagiotis, Lu Henri
Service of Cardiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1010 Lausanne, CH.
J Invasive Cardiol. 2023 Mar;35(3):E136-E142. doi: 10.25270/jic/22.00321. Epub 2023 Jan 26.
Data regarding the prevalence of carotid artery stenosis (CAS) in patients undergoing transcatheter aortic valve implantation (TAVI) are scarce. Whether CAS, especially severe or bilateral, is a predictor of worse prognosis after TAVI is unknown. We aimed to address these questions.
We included all patients who underwent TAVI between 2018 and 2021. Using pre-TAVI carotid Doppler ultrasound, atherosclerosis of the right and left carotid internal arteries was assessed. CAS was defined as moderate (50%-69% stenosis, peak systolic velocity of 125-230 cm/sec) or severe (≥70% stenosis, peak systolic velocity of >230 cm/sec). When both carotid arteries presented with ≥50% stenosis, CAS was defined as bilateral. Endpoints included the 30-day incidence of stroke or transient ischemic attack (TIA), 30-day all-cause mortality, and periprocedural complications.
Among 448 patients, 56 (12.5%) had CAS, of which 15 had bilateral and 15 had severe CAS. Patients with CAS were more often men and had higher rates of peripheral artery disease, coronary artery disease, and previous percutaneous coronary intervention. There was no association between CAS and 30-day stroke or TIA (adjusted hazard ratio [aHR], 2.55; 95% confidence interval [CI], 0.73-8.91; P=.14), even when considering severe CAS only. However, a significant association was found between bilateral CAS and 30-day stroke or TIA (aHR, 8.399; 95% CI, 1.603-44.000; P=.01). No association between CAS and 30-day mortality or periprocedural complications was found.
CAS is common among TAVI patients. While CAS as a whole was not a predictor of neurovascular complications, the subgroup of bilateral CAS was associated with an increased risk of stroke.
关于经导管主动脉瓣植入术（TAVI）患者中颈动脉狭窄（CAS）患病率的数据稀少。CAS，尤其是重度或双侧CAS，是否是TAVI后预后较差的预测因素尚不清楚。我们旨在解决这些问题。
我们纳入了2018年至2021年间接受TAVI的所有患者。使用TAVI前的颈动脉多普勒超声评估左右颈内动脉的动脉粥样硬化情况。CAS被定义为中度（狭窄50%-69%，收缩期峰值流速为125-230厘米/秒）或重度（≥70%狭窄，收缩期峰值流速>230厘米/秒）。当双侧颈动脉狭窄≥50%时，CAS被定义为双侧。终点包括30天内中风或短暂性脑缺血发作（TIA）的发生率、30天全因死亡率和围手术期并发症。
在448例患者中，56例（12.5%）有CAS，其中15例为双侧，15例为重度CAS。有CAS的患者男性更多，外周动脉疾病、冠状动脉疾病和既往经皮冠状动脉介入治疗的发生率更高。CAS与30天中风或TIA之间无关联（调整后风险比[aHR]，2.55；95%置信区间[CI]，0.73-8.91；P = 0.14），即使仅考虑重度CAS时也是如此。然而，发现双侧CAS与30天中风或TIA之间存在显著关联（aHR，8.399；95%CI，1.603-44.000；P = 0.01）。未发现CAS与30天死亡率或围手术期并发症之间存在关联。
CAS在TAVI患者中很常见。虽然总体上CAS不是神经血管并发症的预测因素，但双侧CAS亚组与中风风险增加相关。
