# Suitability for Transcarotid Transcatheter Aortic Valve Replacement in the Japanese Population

## TL;DR

This study examines whether transcarotid TAVR is suitable for Japanese patients, finding that most are eligible despite some anatomical challenges.

## Contribution

The study provides the first detailed analysis of TC-TAVR suitability in the Japanese population.

## Key findings

- Right common carotid arteries were larger but more tortuous than left ones in Japanese patients.
- Peripheral artery disease was a significant negative predictor of TC-TAVR suitability.
- Overall, 91.1% of patients were suitable for TC-TAVR, with 86.3% suitability in the tough-TF group.

## Abstract

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.

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.

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.

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).

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.