Major Clinical Outcomes in Patients with Carotid Artery Stenosis Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-analysis.

Abstract

Data on carotid artery stenosis (CAS) prevalence in patients undergoing transcatheter aortic valve replacement (TAVR) are limited. It remains unclear whether CAS serves as a predictor of worse outcomes following TAVR. This meta-analysis aims to assess the impact of CAS on major clinical outcomes in this population. A comprehensive literature search was conducted across three databases to identify relevant studies. The primary endpoint was the 30-day incidence of Stroke or Transient Ischemic Attack (TIA) in patients with CAS≥50% and CAS≥70%, respectively. Secondary endpoints included in-hospital Stroke/TIA, in-hospital mortality, 30-day mortality, bleeding events, myocardial infarction (MI), acute kidney injury (AKI), periprocedural vascular complications, and permanent pacemaker implantation (PPM) up to 30 days. A total of 15 studies, involving 129,155 patients, were included in the meta-analysis. CAS was associated with higher rates of 30-day Stroke/TIA: 1) CAS ≥50% (Risk Ratio (RR): 1.38, 95% Confidence Intervals (CI): 1.19, 1.59), 2) CAS ≥70% (RR: 1.61, 95% CI: 1.10, 2.36). CAS comorbidity was also linked to increased risk for in-hospital stroke/TIA (RR: 1.73, 95% CI: 1.28, 2.33), 30-day mortality (RR: 1.29, 95% CI: 1.13, 1.47), and 30-day bleeding events (RR: 1.15, 95% CI: 1.08, 1.23). No differences were observed in the rest secondary endpoints. In conclusion, CAS was associated with a higher risk of 30-day and in-hospital cerebrovascular events following TAVR. Patients with CAS are at an increased risk of 30-day all-cause mortality without any impact on in-hospital mortality. Further studies are required to validate our results.