RESUMO
INTRODUCTION: 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. METHODS: 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% stenosis, peak systolic velocity of >230 cm/sec). When both carotid arteries presented with ≥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. RESULTS: 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=.14), 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=.01). No association between CAS and 30-day mortality or periprocedural complications was found. CONCLUSIONS: 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.
Assuntos
Estenose da Valva Aórtica , Estenose das Carótidas , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Substituição da Valva Aórtica Transcateter , Masculino , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/cirurgia , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/epidemiologia , Ataque Isquêmico Transitório/etiologia , Constrição Patológica/etiologia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Resultado do Tratamento , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Valva AórticaRESUMO
Modern communication technologies have opened up new perspectives for modern medicine. Developed and used in many countries since the 1990s, teleconsultation responds to societal change. It facilitates communication between doctors but also between doctors and patients. It helps to improve access to care and reduce health costs. The studies showing its interest in practice are numerous as for example: follow-up of chronic diseases, psychiatric follow-up or post-operative follow-up in outpatient surgery, etc. Teleconsultation is increasingly popular with patients but still encounters cultural and other obstacles by calling into question certain fundamental aspects of the doctor-patient relationship.
Les technologies modernes de communication ont ouvert de nouvelles perspectives pour la médecine moderne. Développée et utilisée dans de nombreux pays depuis les années 90, la téléconsultation répond à l'évolution sociétale. Elle facilite la communication entre médecins, mais également entre médecins et patients. Elle contribue à améliorer l'accès aux soins et à réduire les coûts de la santé. Les études montrant son intérêt en pratique sont nombreuses comme par exemple : suivis de maladies chroniques, psychiatrique ou postopératoire en chirurgie ambulatoire, etc. La téléconsultation est de plus en plus plébiscitée par les patients, mais se heurte encore à des obstacles entre autres culturels en remettant en cause certains aspects fondamentaux de la relation médecin-patient.
