ABSTRACT NUMBER: ESOC2026A263 IMPLICATION OF ROUTINE CAROTID ARTERY DUPLEX BEFORE TRANSCATHETER AORTIC VALVE IMPLANTATION

Abstract Background and aims Transcatheter Aortic Valve Implantation (TAVI) carries a 2–6% risk of stroke, mostly occurring during or within two weeks post-procedure. We investigated whether pre-TAVI carotid duplex scanning provides clinically useful information to enhance procedural safety, specifically examining the relationship between carotid artery stenosis and outcomes. Methods We included 436 consecutive patients undergoing TAVI at our institution between January 2014 and December 2019. Patient characteristics and procedural data were recorded. Carotid duplex was performed in 98% of patients. Early stroke was defined as occurring within 30 days post-TAVI and classified as presumed embolic or hemodynamic based on clinical criteria. Secondary endpoints included the association of carotid artery stenosis with transient ischemic attack (TIA), delirium, and 30-day mortality. Statistical significance was set at p<0.05. Results High-grade carotid stenosis or occlusion was present in 5.3% of patients. Early strokes occurred in 2.75% (n=12), all ischemic, with all but one presumed embolic. Stroke patients were older, had longer hospital stays, and higher mortality than non-stroke patients. No significant association was found between carotid stenosis and stroke risk. However, patients with high-grade stenosis or occluded carotids had significantly higher 30-day mortality compared to those without hemodynamically significant stenosis (10.5% & 16.7% vs. 0.8%; p<0.0001). Conclusions Carotid disease severity does not increase stroke risk during TAVI. Nevertheless, carotid stenosis independently predicts 30-day mortality, highlighting its potential relevance for patient selection and pre-procedural counseling. Conflict of interest Daal, Keunen, Heinen, Schotborgh, Keyhan-Falsafi, Hoohenkerk, Ayan, Marian. Tavy van Kampen and Keunen all these authors have nothing to disclose.