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Carotid Artery Stenting Following Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis: A Case Report
Hiroki Kobayashi1, Ryuta Yamada1, Yuichi Nomura1
1Department of Neurosurgery, Asahi University Hospital, Gifu, Gifu, Japan.
Insights
For older patients with severe aortic stenosis and carotid stenosis, treating aortic stenosis first with transcatheter aortic valve implantation, followed by carotid artery stenting, is a safe strategy.
Area of Science:
- Cardiology
- Neurology
- Vascular Surgery
Background:
- Severe aortic stenosis (AS) and carotid artery stenosis (CAS) pose significant perioperative risks, including cardiac arrest.
- Optimal treatment sequencing for patients with concomitant severe AS and proximal CAS lacks consensus.
- High-risk patients often present with multiple comorbidities, complicating treatment decisions.
Observation:
- An 84-year-old woman with severe AS and severe left proximal internal carotid stenosis was evaluated.
- Cerebral blood flow was normal, suggesting suitability for staged intervention.
- Transcatheter aortic valve implantation (TAVI) for severe AS was performed uneventfully.
Findings:
- A staged approach involving TAVI followed by CAS two months later was successfully implemented.
- The patient experienced no adverse cardiac or cerebrovascular events during the perioperative period.
- This case demonstrates the feasibility of CAS after TAVI in a high-risk elderly patient.
Implications:
- Staged treatment of severe AS and CAS may be a safe and effective strategy for select high-risk patients.
- CAS following TAVI is a viable option when cerebral perfusion is adequate.
- This approach can be particularly beneficial for older patients with multiple comorbidities.
Objective:
During the perioperative period of carotid artery stenting (CAS), severe aortic stenosis (AS) is associated with a risk of serious complications, such as cardiac arrest. There is no consensus regarding the order of treatment for patients with severe AS concomitant with proximal carotid artery stenosis. We herein report a case in which CAS following transcatheter aortic valve implantation for severe AS was safely performed in an older high-risk patient.
Case Presentation:
An 84-year-old woman presented with severe aortic stenosis that required treatment. Magnetic resonance angiography revealed severe left proximal internal carotid stenosis. Cerebral blood flow measurements revealed a normal cerebral perfusion. An uneventful transcatheter aortic valve implantation for severe aortic stenosis was followed by carotid stenting at a 2-month interval.
Conclusion:
Staged treatment may be a safe and effective strategy in high-risk patients with concomitant severe AS and carotid stenosis. In cases with a normal cerebral blood flow, CAS following transcatheter aortic valve implantation can be a reasonable option, especially in older patients with multiple comorbidities.
