Combined approach of carotid endarteriectomy and transcarotid transcatheter aortic valve implantation as a minimally invasive one-step treatment of aortic stenosis: a case report

BACKGROUND: Despite the gold-standard approach for transaortic valve implantation (TAVI) remains transfemoral (TF), alternative approaches are needed in patients who present contraindications to transfemoral access. CASE SUMMARY: We report the case of a 79-year-old female with a symptomatic high-gradient severe aortic stenosis—mean gradient of 43 mmHg—and a significant supra-aortic trunk stenosis (left carotid artery: 90–99%; right carotid artery: 50–70%), and who was hospitalized for progressive dyspnoea New York Heart Association (NYHA) stage III. In this high-risk patient, it was decided to perform a TAVI. Because of a history of stenting of both common iliac arteries in a context of an arterial insufficiency of the lower limbs (Leriche classification stage III) and stenotic thoraco-abdominal aorta atheromatosis, an alternative approach to the transfemoral transaortic valve implantation (TF-TAVI) one was needed. It was decided to perform a combined transcarotid-TAVI (TC-TAVI) with EDWARDS S3 23 mm valve with a left endarteriectomy during the same operating time. DISCUSSION: Our case illustrates an alternative approach to perform a percutaneous aortic valve implantation, despite supra-aortic trunk stenosis, in a high-risk surgical patient contraindicated to a TF-TAVI. Transcarotid transaortic valve implantation remains a safe alternative when TF-TAVI is contraindicated, and the combined approach of carotid endarteriectomy and TC-TAVI offers a minimally invasive one-step treatment in high operative risk patients.