{"id":"12f6680a-b0bb-49c5-b530-b3fe4701a702","slug":"carotid-artery-stenosis-concomitant-with-severe-aortic-stenosis-treated-by-combination-of-staged-angioplasty-and-transcatheter-aortic-valve-implantation-a-case-report","title":"Carotid artery stenosis concomitant with severe aortic stenosis treated by combination of staged angioplasty and transcatheter aortic valve implantation: A case report","authors":["Ryosuke Shintoku","Mikito Hayakawa","Tomoya Hoshi","Sho Okune","Takato Hiramine","Toshihide Takahashi","Hisayuki Hosoo","Yoshiro Ito","Aiki Marushima","Eiichi Ishikawa","Yuji Matsumaru"],"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.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/12f6680a-b0bb-49c5-b530-b3fe4701a702/featured/hero-1781560868542.png","publishDate":"2022-10-14T00:00:00.000Z","doi":"10.25259/SNI_560_2022","categories":["Neurovascular","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2022/10/11930/SNI-13-469.pdf"}