Stroke risk after transcatheter aortic valve replacement in patients with carotid stenosis: A systematic review and meta-analysis

Background: Stroke is a feared complication of transcatheter aortic valve replacement (TAVR). Patients undergoing TAVR typically have multiple comorbidities, such as carotid artery stenosis (CAS). We conducted the present meta -analysis to determine the risk of stroke and mortality following TAVR in patients with CAS. Methods: We searched PubMed/Medline, Scopus, ScienceDirect, and Cochrane Clinical Trials databases for clinical studies that compared CAS >= 50% and CAS >= 70% versus non -CAS TAVR population. The endpoints included the 30 -day incidence of stroke or transient ischemic attack (TIA) and 30 -day all -cause of mortality. Results: We identified seven studies that included 12,418 patients in the CAS group and 102,316 in the control group. CAS >= 50% was not associated with an increased risk of 30 -day stroke or TIA after TAVR [risk ratio (RR): 1.38; 95% confidence interval (95% CI): 0.95 -2.02; p = 0.09]. However, patients with CAS >= 70% had an increased risk of stroke or TIA (RR: 1.43; 95% CI: 1.02 -2.01; p = 0.04). No difference in 30 -day all -cause mortality was observed between CAS >= 50% or CAS >= 70% and control groups (RR: 1.09; 95% CI: 0.79 -1.52; p = 0.59 and RR: 1.11; 95% CI: 0.85 -1.45; p = 0.43, respectively). Conclusions: CAS >= 70% was associated with an increased risk of stroke or TIA following TAVR compared with patients without CAS.