Original Scientific Articles
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Journal of Structural Heart Disease, February 2018, Volume 4, Issue 1:9-16
DOI: 10.12945/j.jshd.2018.032.17
Stroke Prevention With Carotid Compression in Patients Undergoing Transcatheter Aortic Valve Replacement: a Multi-Center Study
Anwar Tandar, MD1, Kapildeo Lotun, MD2, Abdulfattah Saidi, MD1, Brian R. Lindman, MD3,6, David Bull, MD4, Jason Glotzbach, MD4, Craig H. Selzman, MD4, Amit Patel, MD4, Greg Stoddard, PhD5, Elizabeth Dranow, PhD1, Frederick G.P. Welt, MD1
1 Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA
2 Division of Cardiovascular Medicine, Banner Health Center, Phoenix, Arizona, USA
3 Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
4 Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah, USA
5 Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
6 Vanderbilt University Medical Center, Nashville, Tennessee, USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has revolutionized the management of severe aortic stenosis. However, TAVR is associated with several complications, including stroke. Carotid compression has been suggested as a simple maneuver to reduce embolic events during various cardiac procedures. Therefore, we examined the association between carotid compression and the incidence of transient ischemic attack (TIA) and stroke in patients undergoing TAVR.
Methods: This is a retrospective multicenter study of patients who underwent TAVR with and without carotid compression. Primary outcomes were stroke or TIA 72 hours after the procedure and between 72 hours and 30-day follow-up. Data analysis was performed using a propensity score technique with inverse probability weighting.
Results: A total of 306 TAVR patients were included in the study. Group I (n = 188) and II (n = 118) included patients who did not or did undergo carotid compression during TAVR, respectively. The mean age was 82.5 ± 8.2 years in Group I and 78.5 ± 7.6 years in Group II. There was no significant difference in combined stroke or TIA rate 72 hours after the procedure (1.1% vs. 1.9%, P = 0.50) or between 72 hours and 30-day follow-up (2.3% vs 1.6%, P = 0.67).
Conclusions: Carotid compression during the TAVR procedure is not associated with the incidence of composite TIA or stroke after TAVR.
Cite this article as: Tandar A, Lotun K, Saidi A, Lindman BR, Bull D, Glotzbach J, Selzman CH, Patel A, Stoddard G, Dranow E, Welt FG. Stroke Prevention With Carotid Compression in Patients Undergoing Transcatheter Aortic Valve Replacement: a Multi-Center Study. Structural Heart Disease 2018;4(1):9-16. DOI: 10.12945/j.jshd.2018.032.17
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Original Scientific Articles
Journal of Structural Heart Disease, February 2018, Volume 4, Issue 1:9-16
DOI: 10.12945/j.jshd.2018.032.17
Stroke Prevention With Carotid Compression in Patients Undergoing Transcatheter Aortic Valve Replacement: a Multi-Center Study
Anwar Tandar, MD1, Kapildeo Lotun, MD2, Abdulfattah Saidi, MD1, Brian R. Lindman, MD3,6, David Bull, MD4, Jason Glotzbach, MD4, Craig H. Selzman, MD4, Amit Patel, MD4, Greg Stoddard, PhD5, Elizabeth Dranow, PhD1, Frederick G.P. Welt, MD1
1 Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA
2 Division of Cardiovascular Medicine, Banner Health Center, Phoenix, Arizona, USA
3 Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
4 Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah, USA
5 Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
6 Vanderbilt University Medical Center, Nashville, Tennessee, USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has revolutionized the management of severe aortic stenosis. However, TAVR is associated with several complications, including stroke. Carotid compression has been suggested as a simple maneuver to reduce embolic events during various cardiac procedures. Therefore, we examined the association between carotid compression and the incidence of transient ischemic attack (TIA) and stroke in patients undergoing TAVR.
Methods: This is a retrospective multicenter study of patients who underwent TAVR with and without carotid compression. Primary outcomes were stroke or TIA 72 hours after the procedure and between 72 hours and 30-day follow-up. Data analysis was performed using a propensity score technique with inverse probability weighting.
Results: A total of 306 TAVR patients were included in the study. Group I (n = 188) and II (n = 118) included patients who did not or did undergo carotid compression during TAVR, respectively. The mean age was 82.5 ± 8.2 years in Group I and 78.5 ± 7.6 years in Group II. There was no significant difference in combined stroke or TIA rate 72 hours after the procedure (1.1% vs. 1.9%, P = 0.50) or between 72 hours and 30-day follow-up (2.3% vs 1.6%, P = 0.67).
Conclusions: Carotid compression during the TAVR procedure is not associated with the incidence of composite TIA or stroke after TAVR.
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Cite this article as: Tandar A, Lotun K, Saidi A, Lindman BR, Bull D, Glotzbach J, Selzman CH, Patel A, Stoddard G, Dranow E, Welt FG. Stroke Prevention With Carotid Compression in Patients Undergoing Transcatheter Aortic Valve Replacement: a Multi-Center Study. Structural Heart Disease 2018;4(1):9-16. DOI: 10.12945/j.jshd.2018.032.17
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