E-137 carotid artery stenosis in the setting of trans-catheter aortic valve replacement: clinical and technical considerations of carotid stenting

Abstract

Introduction At our institution preoperative work-up for trans-catheter aortic valve replacement (TAVR) includes evaluation of the carotid vessels. We 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 following TAVR at our institution from August 2012 through January 2015. Patient outcomes in the immediate perioperative period were collected to assess the safety and efficacy of carotid stenting. Results Six patients (6.9%, 4 males, 2 females, mean age 82.3 ± 7.17 years) underwent successful carotid stenting either prior to (5 patients) or following (1 patient) TAVR. Average extent of carotid stenosis was 80%±6%, but in each case the diagnosis was incidental and patients were asymptomatic. One patient had an adverse outcome, who suffered acute systolic heart failure during stenting, requiring emergent balloon aortic valvuloplasty and vasopressor therapy. The average length of the stay in the intensive care unit was 4.16 ± 6 days; the average length of hospital stay was 4.5 ± 5.85. All patients were discharged home. None suffered immediate or delayed neurological complications. Conclusion We successfully performed carotid stenting in six patients either prior to or following TAVR with 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. Disclosures V. Ravindra: None. M. Mazur: None. M. Park: None. G. Kumpati: None. A. Patel: None. W. Couldwell: None. P. Taussky: 2; C; Covidien.