Transcarotid transcatheter aortic valve replacement with cerebral embolic protection

There remains concern about the risk of stroke with transcarotid transcatheter aortic valve replacement (TAVR). We describe the use of the Sentinel cerebral protection device with transcarotid TAVR in a patient at high risk for embolic complications. Deployment of the Sentinel filter in the innominate artery accommodated the insertion of the TAVR device through the bovine aortic arch via the contralateral carotid artery. By adapting the "flip-n-flex" technique from our previous transaxillary TAVR experience, we performed left transcarotid TAVR with the Sentinel device in an ergonomic manner and achieved coaxial placement of the transcatheter valve. Inspection of the Sentinel filter after the case revealed captured embolic debris.