Abstract
Abstract Background/Introduction Carotid Artery Stenosis (CAS) is common in elderly patients undergoing Transcatheter Aortic Valve Replacement (TAVR). However, the impact of CAS on the outcomes of TAVR is unclear. Purpose This systematic review and meta-analysis aimed to compare the clinical and periprocedural outcomes in patients with and without CAS undergoing TAVR. Methods PubMed, Embase, and Cochrane databases were searched up to February 2023. We included studies that performed a direct comparison of outcomes of TAVR in CAS versus non-CAS patients. Data were extracted from published reports and the ROBINS-I tool was utilised for quality assessment. Review Manager 5.1 was adopted for statistical analysis. A random-effects model was used to calculate a pooled effect size and 95% confidence interval. Results Five observational studies and 111,915 patients were included. Follow-up ranged from 30 days to 1 year. The mean age was 80.7 ± 8.2 years and 46.3% were female. The risk of stroke or transient ischaemic attack was elevated in the group of patients with CAS (OR 1.44; 95% CI 1.05-1.99; p=0.02; Figure 1A). Similarly, there was an increased risk of myocardial infarction in the CAS group (OR 1.25; 95% CI 1.06-1.47; p= 0.008; Figure 1B). In contrast, all-cause mortality (OR 0.99; 95% CI 0.71-1.37; p=0.94; Figure 2A) and major bleeding (OR 1.14; 95% CI 0.98-1.32; p=0.08; Figure 2B) were not significantly different between CAS and non-CAS groups. There was also no significant difference in acute kidney injury (OR 0.99; 95% CI 0.79-1.23; p=0.99) and new pacemaker implantation (OR 0.95; 95% CI 0.70-1.30; p=0.76) between patients with and without CAS. Conclusions Our findings suggest that CAS is significantly associated with cerebrovascular events and myocardial infarction in patients who undergo TAVR, without a significant impact on all-cause mortality. Further prospective studies are needed for a more granular assessment of additional determinants of this association, such as unilateral vs. bilateral involvement and whether there is a threshold of CAS severity for increased risk.
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