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Staged Versus Concomitant Carotid Endarterectomy and Aortic Valve Replacement: A Case Report and Literature Review

Muhammad Faiq Umar1,2, Shannay E Bellamy3, Muhammad Ahmad3

  • 1Internal Medicine, Mayo Hospital, Lahore, PAK.

Cureus
|January 1, 2024
PubMed

Insights

Managing carotid artery stenosis alongside cardiac surgery is crucial for stroke prevention. This case highlights the complex decisions involved in treating severe bilateral carotid stenosis and aortic stenosis concurrently.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Vascular Surgery

Background:

  • Stroke is a frequent complication following cardiac surgery.
  • Carotid artery stenosis (CAS) is a significant risk factor for perioperative stroke.
  • Optimal management strategies for patients with concurrent severe CAS and cardiac conditions remain debated.

Observation:

  • A 67-year-old male presented with severe aortic stenosis and significant bilateral carotid artery stenosis.
  • The patient had a history of percutaneous coronary intervention and coronary artery bypass grafts.
  • The presence of these comorbidities created a complex clinical scenario regarding the surgical sequence.

Findings:

  • The case illustrates the dilemma between prioritizing carotid endarterectomy versus aortic valve replacement.
  • No definitive guidelines exist for managing severe bilateral CAS in conjunction with complex cardiac conditions beyond coronary artery bypass grafting.

Implications:

  • This case underscores the need for individualized treatment plans in managing synchronous severe carotid stenosis and cardiac disease.
  • Further research is warranted to establish evidence-based guidelines for these challenging surgical scenarios.
  • Improved patient outcomes depend on carefully weighing risks and benefits of staged or simultaneous interventions.

Keywords:
aortic valve surgerybilateral internal carotid artery stenosiscardiac valvular surgerycarotid artery stenting (cas)carotid endarterectomy (cea)combined cardiac surgerycoronary artery bypass grafting(cabg)perioperative strokesevere asymptomatic aortic stenosistavr( transcatheter aortic valve replacement)

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