JACC. Asia · 2026
Suitability for Transcarotid Transcatheter Aortic Valve Replacement in the Japanese Population.
СтатьяНазвание и аннотация: Перевод в очереди
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Nakashima Masaki, Satomi Natsuko, Tazawa Daishi, Kosuga Momo, Maeda Manabu, Teng Yun, Kobayashi Yuta, Saigan Makoto, Toki Yusuke, Enta Yusuke, Miyasaka Masaki, Munehisa Yoshiko, Yamamoto Akihiro, Tada Norio
Аннотация
BACKGROUND: Transcarotid (TC) transcatheter aortic valve replacement (TAVR) has shown favorable outcomes in selected Western populations; however, data on its suitability in patients undergoing TAVR remain scarce.
OBJECTIVES: The purpose of this study was to investigate the anatomical characteristics of the common carotid artery (CCA) and the suitability of Japanese patients for TC-TAVR.
METHODS: This single-center retrospective study included consecutive patients who underwent TAVR between April 2023 and March 2024. Patients were categorized into a tough-transfemoral (TF) group, who may require an alternative approach, and a viable-TF group. TC-TAVR suitability was determined based on the CCA diameter, exposure site calcification, atherosclerotic plaque, and contralateral carotid artery stenosis.
RESULTS: Among 336 patients, the right CCA was larger than the left CCA (6.6 ± 1.0 mm vs 6.4 ± 0.9 mm; P < 0.001) but exhibited greater tortuosity (44 of 336 [13.1%; 95% CI: 9.9%-17.1%] vs 9 of 336 [2.7%; 95% CI: 1.4%-5.0%]; P < 0.001). The tough-TF group had a higher incidence of major vascular complications (12 of 117 [10.3%; 95% CI: 6.0%-17.1%]) compared with the viable-TF group (3 of 219 [1.4%; 95% CI: 0.5%-3.9%]; P < 0.001). Overall suitability for TC-TAVR was high (306 of 336 [91.1%; 95% CI: 87.5%-93.7%]); however, it was significantly lower in the tough-TF group than in the viable-TF group (101 of 117 [86.3%; 95% CI: 78.9%-91.4%] vs 205 of 219 [93.6%; 95% CI: 89.6%-96.2%]; P = 0.042). Multivariate regression analysis identified peripheral artery disease as a negative predictor of suitability (OR: 0.42; 95% CI: 0.19-0.99; P = 0.039).
CONCLUSIONS: Although TC-TAVR suitability was compromised in the tough-TF group, 86% remained suitable, suggesting that TC-TAVR may serve as a promising approach in the Japanese population.
OBJECTIVES: The purpose of this study was to investigate the anatomical characteristics of the common carotid artery (CCA) and the suitability of Japanese patients for TC-TAVR.
METHODS: This single-center retrospective study included consecutive patients who underwent TAVR between April 2023 and March 2024. Patients were categorized into a tough-transfemoral (TF) group, who may require an alternative approach, and a viable-TF group. TC-TAVR suitability was determined based on the CCA diameter, exposure site calcification, atherosclerotic plaque, and contralateral carotid artery stenosis.
RESULTS: Among 336 patients, the right CCA was larger than the left CCA (6.6 ± 1.0 mm vs 6.4 ± 0.9 mm; P < 0.001) but exhibited greater tortuosity (44 of 336 [13.1%; 95% CI: 9.9%-17.1%] vs 9 of 336 [2.7%; 95% CI: 1.4%-5.0%]; P < 0.001). The tough-TF group had a higher incidence of major vascular complications (12 of 117 [10.3%; 95% CI: 6.0%-17.1%]) compared with the viable-TF group (3 of 219 [1.4%; 95% CI: 0.5%-3.9%]; P < 0.001). Overall suitability for TC-TAVR was high (306 of 336 [91.1%; 95% CI: 87.5%-93.7%]); however, it was significantly lower in the tough-TF group than in the viable-TF group (101 of 117 [86.3%; 95% CI: 78.9%-91.4%] vs 205 of 219 [93.6%; 95% CI: 89.6%-96.2%]; P = 0.042). Multivariate regression analysis identified peripheral artery disease as a negative predictor of suitability (OR: 0.42; 95% CI: 0.19-0.99; P = 0.039).
CONCLUSIONS: Although TC-TAVR suitability was compromised in the tough-TF group, 86% remained suitable, suggesting that TC-TAVR may serve as a promising approach in the Japanese population.