Stroke risk much higher for TAVR patients with carotid artery stenosis
Patients with carotid artery stenosis (CAS) may face an increased risk of neurovascular complications after undergoing transcatheter aortic valve replacement (TAVR), according to a new meta-analysis published in The American Journal of Cardiology.[1]
“CAS has been linked to an increased risk of periprocedural cerebrovascular complications in patients undergoing surgical aortic valve replacement and coronary artery bypass graft surgery,” wrote first author Theoni Theodoropoulou, MD, MSc, PhD, a cardiologist with Athens School of Medicine, and colleagues. “However, whether this association holds true for TAVR, particularly in cases of bilateral CAS, remains unclear.”
Theodoropoulou et al. reviewed data from nearly 130,000 patients who originally participated in one of 15 studies from 2016 to 2024. Approximately 11% of those patients presented with CAS of 50% or more, and 0.7% presented with CAS of 70% or more. The mean patient ages from the 15 studies ranged from 80 to 86 years old.
Overall, the group found that patients presenting with CAS of 50% or more faced a 38% higher risk of stroke or transient ischemic attack (TIA) within 30 days of TAVR than patients presenting without CAS.
In addition, a smaller analysis of three different studies found that patients presenting with CAS of 70% or more faced a 61% higher risk of stroke or TIA within 30 days of TAVR.
CAS was also associated with higher risks of in-hospital stroke, in-hospital TIA, 30-day all-cause mortality and bleeding events. When tracking in-hospital all-cause mortality, on the other hand, there was “no significant difference” when patients presented with CAS.
“With the growing adoption of TAVR, it is essential to understand the pathophysiology behind post-procedural complications, especially stroke,” the authors wrote. “The immediate perioperative period presents an increased incidence of stroke events, indicating a potential procedural association. Contributing factors may include intraoperative embolism, transient arterial hypotension during anesthesia or rapid ventricular pacing, and a pre-existing history of cerebrovascular disease.”
They also touched on cerebral embolic protection devices, saying their “utility in patients with CAS is limited.”
“While embolic debris is detected in nearly all TAVR patients, evidence on the effectiveness of cerebral protection devices in reducing stroke incidence and severity remains inconsistent,” they added. “These devices may help mitigate stroke risk in patients with CAS undergoing TAVR, though further research is needed to identify subgroups that would benefit most.”
Another key takeaway from the team’s analysis is that carotid revascularization prior to TAVR may help reduce the risk of neurovascular complications. While some industry guidelines already recommend this step for patients with CAS of more than 60%, it is possible that pre-TAVR revascularization in patients with CAS of 50% or more may provide value. Again, the authors noted that more research is still needed.
Theodoropoulou and colleagues concluded that CAS screening for TAVR patients, if affordable and noninvasive, may be an effective treatment strategy.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.