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Catheter Cardiovasc Interv. 2013 Mar;81(4):618-22. doi: 10.1002/ccd.24588. Epub 2013 Feb 12.

Transcatheter aortic valve implantation through a diseased left common carotid artery: combined approach with endarterectomy and left carotid-subclavian bypass.

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  • 1Department of Cardiology, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil. marco.aurelio@haoc.com.br

Abstract

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.

Copyright © 2012 Wiley Periodicals, Inc.

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