No abstract

Data regarding the prevalence of carotid artery stenosis (CAS) in patients undergoing transcatheter aortic valve implantation (TAVI) are scarce. Whether CAS, especially severe or bilateral, is a predictor of worse prognosis after TAVI is unknown. We aimed to address these questions. We included all patients who underwent TAVI between 2018 and 2021. Using pre-TAVI carotid Doppler ultrasound, atherosclerosis of the right and left carotid internal arteries was assessed. CAS was defined as moderate (50–69% stenosis, peak systolic velocity of 125–230 cm/sec) or severe (≥ 70%, > 230 cm/sec). When both carotid arteries presented ≥ 50% stenosis, CAS was defined as bilateral. Endpoints included the 30-day incidence of stroke or transient ischemic attack (TIA), 30-day all-cause mortality and periprocedural complications. Among 448 patients, 56 (12.5%) had CAS, of which 15 had bilateral and 15 had severe CAS. Patients with CAS were more often men and had higher rates of peripheral artery disease, coronary artery disease and previous percutaneous coronary intervention. There was no association between CAS and 30-day stroke or TIA (adjusted hazard ratio [aHR] 2.55, 95% confidence interval [CI] 0.73–8.91, p = 0.142), even when considering severe CAS only. However, a significant association was found between bilateral CAS and 30-day stroke or TIA (aHR 8.399, 95%CI 1.603-44.000, p = 0.012). No association between CAS and 30-day mortality or periprocedural complications was found. CAS is common among TAVI patients. While CAS as a whole was not a predictor of neurovascular complications, the subgroup of bilateral CAS was associated with an increased risk of stroke.

Prévention des complications thromboemboliques des patients adultes porteurs de cardiopathie congénitaleLes complications thromboemboliques des adultes porteurs d'une cardiopathie congénitale sont fréquentes et responsables d'une importante morbi-mortalité. Leur prévention passe fréquemment par la mise en place d'une thromboprophylaxie au long cours. Dans cet article, nous discutons des spécificités qui doivent être prises en compte lors de la stratification du risque thromboembolique de ces patients, des différentes stratégies thérapeutiques et notamment de la place des anticoagulants oraux directs. Prevention of thromboembolic complications in adult congenital heart diseaseThromboembolic complications in adults with congenital heart disease are frequent and responsible for significant morbidity and mortality. Their prevention frequently requires long-term thromboprophylaxis. In this article, we discuss the specificities that must be considered when stratifying the thromboembolic risk in these patients, the different therapeutic strategies, particularly the place of direct oral anticoagulants.