Hemodynamic changes in supra-aortic trunks after transcatheter aortic valve implantation at duplex ultrasound examination

Aims: The hemodynamic consequences of aortic stenosis (AS) on supra-aortic trunks may play a potential role during the diagnosis of concomitant internal carotid artery (ICA) stenosis by dampening blood flow velocity. To investigate the effect of AS on ICA blood flow we evaluated carotid and vertebral blood flow velocity indexes in patients undergoing transcatheter aortic valve implantation (TAVI). Methods and results: Patients admitted for endovascular treatment of a severe AS underwent supra-aortic duplex ultrasound examination prior and after TAVI to be enrolled in the study. Patients with symptomatic or severe ICA stenosis were excluded. Patients with other cardiac impairments that could configure a confounding factor were excluded. One hundred and five patients of a median age of 80 years met the study inclusion criteria. The median peak systolic velocity (PSV) of the assessed supra-aortic arteries increased after TAVI: common carotid artery (CCA) from 64.5 to 78.0 cm/s (+24%; P < 0.01), ICA from 67.0 to 90.5 cm/s (+36%; P < 0.01), and vertebral artery (VA) from 44.0 to 51.0 cm/s (+17%; P < 0.01). Median end-diastolic velocity (EDV) also increased: CCA from 12.0 to 14.0 cm/s (+12%; P < 0.01), ICA from 19.0 to 23.0 cm/s (+20%; P < 0.01), and VA from 10.0 to 11.0 cm/s (+18%; P < 0.01). In parallel, median acceleration time (AT) decreased markedly at each site: CCA from 0.180 to 0.100 s (-44%; P < 0.01), ICA from 0.195 to 0.100 s (-41%; P < 0.01), and VA from 0.180 to 0.100 s (-36%; P < 0.01). Conclusion: Severe AS significantly affects supra-aortic arteries blood flow as assessed by duplex, by decreasing both PSV and EDV and increasing AT. This study suggests that carotid ultrasound criteria to assess ICA stenosis severity should be re-evaluated in larger multi-centre studies to validate their predictive values in patients with concomitant AS.