Stroke Risk in TAVR Patients with Carotid Artery Stenosis (CAS)
Stroke Risk in TAVR Patients with Carotid Artery Stenosis (CAS)
Source: Article in Press — Meta-analysis published on Sept 16, 2025, in The American Journal of Cardiology.
1. Background
• Carotid artery stenosis (CAS) is linked to higher stroke risk in surgical aortic valve replacement (SAVR) and CABG.
• The impact of CAS on transcatheter aortic valve replacement (TAVR) patients has been less clear, especially with bilateral CAS.
2. Study Details
• Meta-analysis of ~130,000 patients from 15 studies (2016–2024).
• Mean age: 80–86 years.
• 11% had CAS ≥50%, 0.7% had CAS ≥70%.
3. Main Findings
• CAS ≥50% → 38% higher risk of stroke/TIA within 30 days post-TAVR.
• CAS ≥70% → 61% higher risk of stroke/TIA within 30 days.
• CAS also linked to:
• Higher in-hospital stroke & TIA.
• Higher 30-day all-cause mortality & bleeding events.
• No significant difference in in-hospital all-cause mortality.
4. Mechanisms of Risk
• Periprocedural embolism.
• Arterial hypotension during anesthesia or rapid pacing.
• Pre-existing cerebrovascular disease.
5. Cerebral Embolic Protection Devices
• Embolic debris common in nearly all TAVR cases.
• Evidence on protection devices inconsistent in reducing stroke risk.
• May help CAS patients, but more data needed to identify subgroups.
6. Carotid Revascularization
• May reduce neurovascular complications before TAVR.
• Options include carotid endarterectomy (CEA) and carotid artery stenting (CAS).
• CEA is gold standard if surgical risk is low to intermediate.
• CAS is preferred in high surgical risk patients or when performed as part of an interventional cardiology practice..
• Guidelines recommend for CAS >60%, with possible value at ≥50%.
7. Conclusion
• Screening for CAS in TAVR patients (if affordable and noninvasive) could be effective.
• More research required on:
• Appropriate severity levels for revascularization.
• Subgroups benefiting from cerebral protection.
Clinical Takeaway:
Stroke risk after TAVR is significantly higher in patients with moderate-to-severe CAS. Routine carotid screening and considering revascularization (CEA for low–intermediate risk, CAS for high-risk) before TAVR may improve outcomes.
