Related Experiment Videos
Carotid artery disease and periprocedural stroke risk after transcatheter aortic valve implantation
Parthasarathy D Thirumala1, Sruthi Muluk2, Reshmi Udesh3
1Department of Neurological Surgery and Neurology; Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
Insights
Bilateral carotid disease significantly increases stroke risk after transcatheter aortic valve implantation (TAVI). Preoperative screening for carotid stenosis is recommended to identify high-risk patients before TAVI procedures.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Neurology
Background:
- Transcatheter aortic valve implantation (TAVI) is a common procedure for aortic stenosis.
- Perioperative stroke is a serious complication following TAVI.
- Identifying independent risk factors for perioperative stroke is crucial for patient management.
Purpose of the Study:
- To investigate the association between carotid stenosis (CS) and other risk factors with perioperative stroke after TAVI.
- To determine the independent predictors of stroke in patients undergoing TAVI.
Main Methods:
- Analysis of data from the National Inpatient Sample database.
- Identification of patients who underwent TAVI using ICD-9-CM codes.
- Multivariate analysis to assess the association of preoperative and perioperative factors with stroke.
Main Results:
- A total of 7566 patients undergoing TAVI were analyzed (2012-2013).
- The overall perioperative stroke rate was 2.79%, predominantly ischemic (94.6%).
- Independent risk factors for stroke included female gender, higher van Walraven score, bilateral CS, and TAVI with cardiopulmonary bypass.
Conclusions:
- Bilateral carotid disease is a significant independent risk factor for perioperative stroke post-TAVI.
- Preoperative carotid Doppler screening is recommended to identify high-risk individuals.
- Female gender is associated with an increased risk of carotid disease and subsequent stroke.
Objective/Background:
To examine the role of carotid stenosis (CS) and other independent risk factors of perioperative stroke, following transcatheter aortic valve implantation (TAVI).
Materials And Methods:
Using data from the National Inpatient Sample database for analysis, patients who underwent TAVI were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Various preoperative and perioperative risk factors and their association with perioperative strokes were studied.
Results:
Data on 7566 patients who underwent a TAVI procedure from 2012 to 2013 were extracted. The average age of the patient population was 81.2 ± 0.32 years. The overall perioperative stroke rate in our patient cohort was 2.79%. Majority (94.6%) of the strokes were ischemic. Multivariate analysis showed the following independent risk factors for perioperative strokes after TAVI: female gender odds ratio (OR) = 2.25 (95% confidence interval [CI], 1.42-3.57), higher van Walraven score OR = 6.6 (95% CI = 3.71-11.73), bilateral CS OR = 4.46 (95% CI = 2.03-9.82), and TAVI with a cardiac procedure done under cardiopulmonary bypass OR = 2.84 (95% CI = 1.57-5.14).
Conclusion:
Bilateral carotid disease is a significant risk factor for perioperative strokes following TAVI. Preoperative screening with carotid Doppler to identify high-risk patients appears to be warranted. In addition, patients of female gender were found to have an increased risk for carotid disease.