title: Transcatheter aortic valve implantation through a diseased left common carotid artery: combined approach with endarterectomy and left carotid-subclavian bypass.
abstract: We report a case of transcatheter aortic valve implantation (TAVI) with the self-expanding Medtronic CoreValve bioprosthesis (Medtronic, Minneapolis, MI) through a diseased left common carotid (LCC) artery. This 81-year-old male patient presented with heart failure due to a severe degenerative aortic valve stenosis. Comorbidities included diabetes, hypertension, and dyslipidemia as well as peripheral and coronary artery disease, resulting in a logistic EuroScore II of 25.9%. Consequently, he was rejected to undergo surgery and a transcatheter approach was planned. Due to severe peripheral vascular disease with iliofemoral lesions, significant calcifications and unfavourable angulations of the innominate artery as well as prior bypass surgery precluding a direct aortic and subclavian approach, none of the established access sites were suitable. Therefore, we considered a left carotid access, which had to be combined with a surgical endarterectomy for treatment of a significant common carotid bifurcation stenosis and left subclavian-LCC permanent tunnel bypass graft. The procedure was successful without cardiac, cerebrovascular, or access complications. This case illustrates a true heart team approach, establishing a unique access for TAVI for patients without regular access options.
authors.affiliation: Department of Cardiology, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil. marco.aurelio@haoc.com.br
authors.forename: Marco A
authors.initials: MA
authors.lastname: Magalhães
authors.forename: Januário M
authors.initials: JM
authors.lastname: Souza
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000601:surgery*; D016894:Endarterectomy, Carotid; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D015641:Radiography, Interventional; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D058017:Vascular Grafting