We reviewed patients who underwent carotid stenting in the setting of preoperative work-up or after TAVR from August 2012 through January 2015. Perioperative patient outcomes were collected to assess the safety and efficacy of carotid stenting.
Five patients (4 men, 1 woman; median age, 83 years; range, 72–88 years) underwent successful carotid stenting before (median, 30 days before; range, 2 days–3 months) TAVR. The median extent of carotid stenosis was 80% (range, 75%–90%), but the diagnoses were incidental and all patients were asymptomatic. One patient suffered acute systolic heart failure during stenting requiring emergent balloon aortic valvuloplasty and vasopressor therapy. Median intensive care unit stay was 1 day (range, 1–16 days) for all patients, and 1 day for patients treated electively. The median hospital stay was 1 day (range, 1–16 days) for all patients, and 1 day for patients treated electively. All patients were discharged home. None suffered immediate or delayed neurological complications.
We successfully performed carotid stenting in 5 patients before TAVR for 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.