{"id":8802,"date":"2025-09-29T20:46:26","date_gmt":"2025-09-29T17:46:26","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=8802"},"modified":"2025-09-29T20:46:26","modified_gmt":"2025-09-29T17:46:26","slug":"stroke-risk-in-tavr-patients-with-carotid-artery-stenosis-cas","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/stroke-risk-in-tavr-patients-with-carotid-artery-stenosis-cas\/","title":{"rendered":"Stroke Risk in TAVR Patients with Carotid Artery Stenosis (CAS)"},"content":{"rendered":"
Stroke Risk in TAVR Patients with Carotid Artery Stenosis (CAS)<\/div>\n
<\/div>\n
Source: Article in Press \u2014 Meta-analysis published on Sept 16, 2025, in The American Journal of Cardiology.<\/div>\n
<\/div>\n
1. Background<\/span><\/div>\n
\u2022 Carotid artery stenosis (CAS) is linked to higher stroke risk in surgical aortic valve replacement (SAVR) and CABG.<\/span><\/div>\n
\u2022 The impact of CAS on transcatheter aortic valve replacement (TAVR) patients has been less clear, especially with bilateral CAS.<\/span><\/div>\n
2. Study Details<\/span><\/div>\n
\u2022 Meta-analysis of ~130,000 patients from 15 studies (2016\u20132024).<\/span><\/div>\n
\u2022 Mean age: 80\u201386 years.<\/span><\/div>\n
\u2022 11% had CAS \u226550%, 0.7% had CAS \u226570%.<\/span><\/div>\n
3. Main Findings<\/span><\/div>\n
\u2022 CAS \u226550% \u2192 38% higher risk of stroke\/TIA within 30 days post-TAVR.<\/span><\/div>\n
\u2022 CAS \u226570% \u2192 61% higher risk of stroke\/TIA within 30 days.<\/span><\/div>\n
\u2022 CAS also linked to:<\/span><\/div>\n
\u2022 Higher in-hospital stroke & TIA.<\/span><\/div>\n
\u2022 Higher 30-day all-cause mortality & bleeding events.<\/span><\/div>\n
\u2022 No significant difference in in-hospital all-cause mortality.<\/span><\/div>\n
4. Mechanisms of Risk<\/span><\/div>\n
\u2022 Periprocedural embolism.<\/span><\/div>\n
\u2022 Arterial hypotension during anesthesia or rapid pacing.<\/span><\/div>\n
\u2022 Pre-existing cerebrovascular disease.<\/span><\/div>\n
5. Cerebral Embolic Protection Devices<\/span><\/div>\n
\u2022 Embolic debris common in nearly all TAVR cases.<\/span><\/div>\n
\u2022 Evidence on protection devices inconsistent in reducing stroke risk.<\/span><\/div>\n
\u2022 May help CAS patients, but more data needed to identify subgroups.<\/span><\/div>\n
6. Carotid Revascularization<\/span><\/div>\n
\u2022 May reduce neurovascular complications before TAVR.<\/span><\/div>\n
\u2022 Options include carotid endarterectomy (CEA) and carotid artery stenting (CAS).<\/span><\/div>\n
\u2022 CEA is gold standard if surgical risk is low to intermediate.<\/span><\/div>\n
\u2022 CAS is preferred in high surgical risk patients or when performed as part of an interventional cardiology practice..<\/span><\/div>\n
\u2022 Guidelines recommend for CAS >60%, with possible value at \u226550%.<\/span><\/div>\n
7. Conclusion<\/span><\/div>\n
\u2022 Screening for CAS in TAVR patients (if affordable and noninvasive) could be effective.<\/span><\/div>\n
\u2022 More research required on:<\/span><\/div>\n
\u2022 Appropriate severity levels for revascularization.<\/span><\/div>\n
\u2022 Subgroups benefiting from cerebral protection.<\/span><\/div>\n
<\/div>\n
Clinical Takeaway:<\/div>\n
Stroke risk after TAVR is significantly higher in patients with moderate-to-severe CAS. Routine carotid screening and considering revascularization (CEA for low\u2013intermediate risk, CAS for high-risk) before TAVR may improve outcomes.<\/div>\n
<\/div>\n
https:\/\/www.ajconline.org\/article\/S0002-9149(25)00555-7\/fulltext<\/a><\/div>\n
<\/div>\n","protected":false},"excerpt":{"rendered":"

Stroke Risk in TAVR Patients with Carotid Artery Stenosis (CAS) Source: Article in Press \u2014 Meta-analysis published on Sept 16, 2025, in The American Journal of Cardiology. 1. Background \u2022 Carotid artery stenosis (CAS) is linked to higher stroke risk in surgical aortic valve replacement (SAVR) and CABG. \u2022 The impact of CAS on transcatheter […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8802","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8802","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=8802"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8802\/revisions"}],"predecessor-version":[{"id":8803,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8802\/revisions\/8803"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=8802"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=8802"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=8802"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}