Transcatheter aortic valve implantation improves carotid and vertebral arterial blood flow in patients with severe aortic stenosis: practical role of orthostatic stress test

Abstract

Background There are no data on the impact of transcatheter aortic valve implantation (TAVI) on carotid and vertebral arterial blood flow. Our aim was to assess the effects of the orthostatic stress test on carotid and vertebral artery blood flow in patients with severe aortic stenosis (AS) undergoing TAVI. Hypothesis TAVI may have beneficial effect on carotid and vertebral artery flow in patients with severe aortic stenosis. Methods Thirty carefully selected patients with severe AS undergoing TAVI were enrolled. Peak systolic blood‐flow velocity and end‐diastolic velocity in the common carotid artery, internal carotid artery, and vertebral artery, as well as spectral analysis of flow pattern with time‐averaged maximum velocity (centimeters per second), time‐averaged mean velocity (centimeters per second), and flow volume (milliliters per minute) on both sides were measured by duplex ultrasound. Measurements were performed in the supine position and at 1 to 2 minutes after the assumption of the standing position at baseline and 3 months after TAVI. Results All duplex ultrasound parameters assessed in the supine position have significantly improved in patients after TAVI as compared to baseline (P < 0.001 for all). The orthostatic stress test induced decrease of carotid and vertebral arterial flow velocities in AS patients before and after TAVI. However, the drop in velocities and flow volume was numerically lower after TAVI. Conclusions TAVI may have some beneficial effect on extracranial artery blood flow by minimalization of its decrease as a response to orthostatic stress.

Association of Increased Vascular Stiffness with Cardiovascular Death and Heart Failure Episodes Following Intervention on Symptomatic Degenerative Aortic Stenosis

“…However, in a TAVI population, Terentes-Printzios et al showed that the arterial system exhibited increased stiffness in response to acute relief of the obstruction following intervention, which was retained in the long term [25]. Of note, in this high-risk subset of patients, such as patients referred for TAVI, the intervention on the valve has a beneficial effect on supra-aortic artery flow parameters during the orthostatic stress test, resulting from the alleviated obstruction to cerebral in-flow [26]. On the other hand, Cantürk et al did not observe a significant change in PWV values following AVR [27].…”

Predictors of syncope in patients with severe aortic stenosis: The role of orthostatic unload test

“…In the present study, however, mean PSV in carotid arteries were highly associated with syncope among all Doppler ultrasound parameters. Moreover, citing another study, the aim was to assess the effects of the orthostatic stress test on carotid and vertebral artery blood flow in patients with severe AS undergoing TAVI [18]. All duplex ultrasound parameters assessed in supine position have significantly improved in patients after TAVI as compared to baseline.…”

Predictive value of carotid artery ultrasonography for the risk of coronary artery disease

“…Four carotid segments were assessed: common carotid artery (CCA), common carotid artery bifurcation, internal carotid artery (ICA), and external carotid artery (ECA). Carotid artery stenoses were categorized by percent diameter stenosis as mild (<50%), moderate (51%‐70%), or severe (>70%) according to North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria 25 . Details of carotid artery assessment have been previously described 26 , and the acquisition protocol was previously used in the Cardiovascular Health Study 27 .…”