Current cardiology reports
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Transcatheter aortic valve replacement (TAVR) has recently emerged as an alternative to surgical aortic valve replacement for patients with severe aortic stenosis who are at "high risk" or deemed inoperable. Careful pre-procedural preparation requires multi-modality imaging. Intra-procedural imaging frequently relies on transesophageal echocardiography (TEE). This review will discuss the role of TEE in pre-implantation assessment, intra-procedural guidance, and post-implantation evaluation.
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Based on several randomized clinical trials, carotid revascularization has been shown to reduce future stroke risk among individuals with severe asymptomatic carotid stenosis. However, a well-recognized problem with such prophylactic intervention is the risk of periprocedural stroke, death, or myocardial infarction. If actual stroke risk with asymptomatic carotid stenosis can be reduced significantly by aggressive medical management, carotid revascularization may yield marginal benefit or even cause harm especially in those with limited life expectancy. ⋯ Others feel such conclusions cannot be made with observational data alone. In the midst of this controversy, it is important that clinicians perform carotid revascularization on a case by case basis while ensuring optimal medical management in all patients. An algorithmic approach to decision making based on available evidence will enable clinicians to personalize patient management with efficiency.