Carotid Artery Stenosis in the Setting of Transcatheter Aortic Valve Replacement: Clinical and Technical Considerations of Carotid Stenting

Objective No consensus exists regarding the safety and efficacy of treatment of carotid stenosis before transcatheter aortic valve replacement (TAVR). Our objective was to review our series of patients treated for carotid stenosis with stenting in the setting of severe aortic valve disease and TAVR to evaluate its safety and efficacy. Methods We reviewed patients who underwent carotid stenting in the setting of preoperative work-up or after TAVR from August 2012 through January 2015. Perioperative patient outcomes were collected to assess the safety and efficacy of carotid stenting. Results Five patients (4 men, 1 woman; median age, 83 years; range, 72-88 years) underwent successful carotid stenting before (median, 30 days before; range, 2 days-3 months) TAVR. The median extent of carotid stenosis was 80% (range, 75%-90%), but the diagnoses were incidental and all patients were asymptomatic. One patient suffered acute systolic heart failure during stenting requiring emergent balloon aortic valvuloplasty and vasopressor therapy. Median intensive care unit stay was 1 day (range, 1-16 days) for all patients, and 1 day for patients treated electively. The median hospital stay was 1 day (range, 1-16 days) for all patients, and 1 day for patients treated electively. All patients were discharged home. None suffered immediate or delayed neurological complications. Conclusions We successfully performed carotid stenting in 5 patients before TAVR for severe aortic pathology. These patients require intensive care and careful monitoring. Larger prospective studies are needed to determine whether carotid stenting in the setting of TAVR can provide long-term neurological benefits.