Conflict of Interest: Dr. Eberhard Grube is consultant and proctor for Medtronic.
Valvular and Structural Heart Diseases
Transcatheter aortic valve implantation through a diseased left common carotid artery: Combined approach with endarterectomy and left carotid-subclavian bypass
Version of Record online: 12 FEB 2013
Copyright © 2012 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions
Volume 81, Issue 4, pages 618–622, March 2013
How to Cite
Magalhães, M. A., Souza, J. M. and Grube, E. (2013), Transcatheter aortic valve implantation through a diseased left common carotid artery: Combined approach with endarterectomy and left carotid-subclavian bypass. Cathet. Cardiovasc. Intervent., 81: 618–622. doi: 10.1002/ccd.24588
- Issue online: 22 FEB 2013
- Version of Record online: 12 FEB 2013
- Accepted manuscript online: 6 AUG 2012 05:28AM EST
- Manuscript Accepted: 30 JUL 2012
- Manuscript Revised: 1 JUL 2012
- Manuscript Received: 25 MAY 2012
- vascular access;
- aortic valve stenosis
We report a case of transcatheter aortic valve implantation (TAVI) with the self-expanding Medtronic CoreValve bioprosthesis (Medtronic, Minneapolis, MI) through a diseased left common carotid (LCC) artery. This 81-year-old male patient presented with heart failure due to a severe degenerative aortic valve stenosis. Comorbidities included diabetes, hypertension, and dyslipidemia as well as peripheral and coronary artery disease, resulting in a logistic EuroScore II of 25.9%. Consequently, he was rejected to undergo surgery and a transcatheter approach was planned. Due to severe peripheral vascular disease with iliofemoral lesions, significant calcifications and unfavourable angulations of the innominate artery as well as prior bypass surgery precluding a direct aortic and subclavian approach, none of the established access sites were suitable. Therefore, we considered a left carotid access, which had to be combined with a surgical endarterectomy for treatment of a significant common carotid bifurcation stenosis and left subclavian-LCC permanent tunnel bypass graft. The procedure was successful without cardiac, cerebrovascular, or access complications. This case illustrates a true heart team approach, establishing a unique access for TAVI for patients without regular access options. © 2012 Wiley Periodicals, Inc.