A systematic review of transcatheter aortic valve implantation via carotid artery access.

Background: The carotid artery is a novel access route for transcatheter aortic valve implantation (TAVI). This may represent a viable alternative in patients unsuitable for TAVI via traditional transfemoral access, up to 20%, as well as other access routes such as subclavian, transapical and aortic. This systematic review summarises the current evidence for its safety and feasibility.

Methods: A systematic review was conducted as per the Preferred Reporting Instructions for Systematic Reviews and Meta-analysis (PRISMA) guidelines using five electronic databases.

Results: 16 studies were identified, including three prospective cohort studies, one retrospective cohort study, three case series and eight case reports. Data on 74 patients (mean age 76.9years) was extracted including pre-operative work-up, technical procedure details and outcomes. This found 1 intraoperative death, 2 further deaths within 30days, two incidences of transient ischaemic attack, no incidences of stroke, myocardial infarction, carotid access site complications or infection, 1 patient required new dialysis and 1 patient had an intraoperative dissection which resolved. Follow-up from 30days to 1year showed symptomatic improvement and echocardiographic improvement in line with those seen in transfemoral TAVI.

Conclusions: The available data on TAVI via carotid access demonstrate technical feasibility with comparable outcomes to other traditional access routes. A low number of patients, heterogeneous clinical endpoints and relatively short follow-up periods limit formal meta-analysis and firmer conclusions. For patients in which other access routes are impossible, TAVI via carotid access represents a viable and potentially crucial alternative in patients who might otherwise be untreatable.