Abstract 6190: Outcomes of Carotid Stenting in Patients with Concomitant Severe Carotid and Aortic Stenosis Prior to Aortic Valve Replacement

Abstract

Introduction: Carotid stenosis increases the risk for perioperative stroke during open heart surgery. Patients with concomitant severe carotid and aortic stenosis (AS) are frequently referred for carotid intervention prior to aortic valve replacement. Hypothesis: We hypothesized that carotid stenting can be safe and efficacious in the setting of severe AS. Methods: Of the total of 829 consecutive patients that underwent carotid interventions from 1998 –2005 at the Cleveland Clinic, 52 patients (65% male, age 78.82 ± 26.16 years) with severe AS (aortic valve area ≤ 1.0 cm 2 , 0.71 ± 0.15 cm 2 ) were included. Demographic, echocardiographic, and angiographic data were obtained prospectively. Our primary endpoints were stroke, transient ischemic attacks (TIAs), or death. Results: The mean STS Mortality scores for all groups were 6.85 ± 4.53% (n=46), six patient scores were immeasurable. There were no procedural strokes or mortality. TIA occurred in 1 patient during carotid stenting. Thirty day mortality was 6% (2 patients with LV-EF <20% died from heart failure and arrhythmia and 1 died from pulmonary embolism). Two other patients with depressed EF expired >30 days after carotid stenting prior to planned aortic valve replacement (AVR). AVR was performed in 29 of the 52 patients (26 patients ≥ 30 days post carotid stenting and 3 patients <15 days post carotid stenting). Of the remaining 23 patients, AVR was not performed due to death (n=5), high surgical risk from medical comorbidities (n=7), and patient refusal (n=3). Close monitoring and reassessment was recommended in 8 patients with asymptomatic AS. The mean STS mortality scores for patients who underwent AVR and who did not have AVR were 6.88 ± 5.05% and 6.81 ± 4.08% respectively (p=ns). Conclusions: Carotid interventions can be safely accomplished in patients with severe AS prior to AVR.