Related Experiment Video
Updated: May 19, 2026
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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Carotid artery access for transcatheter aortic valve replacement
Robert A Guyton1, Peter C Block, Vinod H Thourani
1Division of Cardiovascular Surgery and Division of Cardiology, Emory University Hospitals, Emory University School of Medicine, Atlanta, GA.
Summary
Transcatheter aortic valve replacement (TAVR) was successfully performed using carotid artery access in three patients unsuitable for other procedures. This approach offers a viable alternative for complex cases lacking conventional vascular access options.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Surgical Innovation
Background:
- Transcatheter aortic valve replacement (TAVR) is a standard treatment for aortic stenosis.
- Patient selection for TAVR typically relies on suitable vascular access, often femoral or subclavian.
- Certain patient populations present challenges due to anatomical limitations or prior interventions, precluding standard access routes.
Observation:
- Three patients requiring TAVR were identified as ineligible for thoracotomy or minimal access surgery.
- These patients also lacked alternative vascular access sites suitable for standard TAVR sheaths.
- Carotid artery access was explored as a potential alternative route for TAVR delivery.
Findings:
- Successful TAVR was achieved in all three patients utilizing carotid artery access.
- Antegrade carotid perfusion was maintained throughout the procedure.
- Retrograde insertion of the TAVR delivery sheath was accomplished without neurological complications or other sequelae.
Implications:
- Carotid artery access represents a novel and feasible approach for TAVR in highly selected, complex patients.
- This technique expands the applicability of TAVR to individuals with limited or no conventional vascular access options.
- Further research may validate carotid access as a routine alternative in challenging TAVR cases.
