Carotid artery stenosis concomitant with severe aortic stenosis treated by combination of staged angioplasty and transcatheter aortic valve implantation: A case report

Ryosuke Shintoku; Mikito Hayakawa; Tomoya Hoshi; Sho Okune; Takato Hiramine; Toshihide Takahashi; Hisayuki Hosoo; Yoshiro Ito; Aiki Marushima; Eiichi Ishikawa; Yuji Matsumaru

doi:10.25259/SNI_560_2022

Carotid artery stenosis concomitant with severe aortic stenosis treated by combination of staged angioplasty and transcatheter aortic valve implantation: A case report

Surg Neurol Int. 2022 Oct 14:13:469. doi: 10.25259/SNI_560_2022. eCollection 2022.

Authors

Affiliations

¹ Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
² Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
³ Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
⁴ Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan.

Abstract

Background: When severe aortic stenosis (AS) is concomitant with carotid stenosis, carotid artery stenting (CAS) will become a high-risk procedure because baroreceptor reflex-induced bradycardia and hypotension may cause irreversible circulatory collapse. When carotid stenosis-related misery perfusion is present, the risk of cerebral hyperperfusion syndrome increases after carotid revascularization. We report a case of severe carotid disease concomitant with severe AS successfully treated by a combination of staged angioplasty (SAP) and transcatheter aortic valve implantation (TAVI).

Case description: An 86-year-old man presented with transient deterioration of mental status and sluggish responsiveness continuous from the previous day. Magnetic resonance imaging of the brain revealed a right putaminal infarction, occlusion of the right internal carotid artery (ICA), and severe stenosis of the left ICA. Severe AS was diagnosed and single-photon emission computed tomography showed misery perfusion at the bilateral ICA territories. We performed a staged treatment consisting of SAP for the left carotid stenosis and TAVI. A first-stage carotid angioplasty was performed, followed by TAVI 2 weeks later and second-stage CAS 1 week after that. There were no apparent periprocedural complications throughout the clinical course.

Conclusion: Combining SAP and TAVI may be an effective treatment option for severe carotid stenosis with misery perfusion concomitant with severe AS.

Keywords: Carotid artery stenting; Cerebral hyperperfusion syndrome; Severe aortic stenosis; Staged angioplasty; Transcatheter aortic valve implantation.

Publication types

Case Reports