Catheter Cardiovasc Interv. 2026 Jul 10. doi: 10.1002/ccd.70741. Online ahead of print.
ABSTRACT
Severe aortic stenosis (AS) carries a poor prognosis when symptomatic, particularly in cardiogenic shock (CS). Emergency transcatheter aortic valve replacement (TAVR) is rarely performed but may represent a rescue therapy. Coexistent carotid artery stenosis (CAS) further increases procedural risk. We report the case of an 83-year-old female patient with severe AS and beginning CS. Imaging revealed severe right internal CAS and occlusion of the left internal carotid artery. Despite the use of norepinephrine, the patient progressed to deteriorating CS with acute kidney injury and impaired mental status. Given high surgical risk, a combined strategy was performed: right carotid stenting followed by transfemoral TAVR. Post-procedure, renal replacement therapy was initiated with rapid recovery of renal function. The patient was hemodynamically stabilized and discharged 14 days after the procedure with normalized ventricular function and a well-functioning prosthesis. This case illustrates the feasibility of consecutive transfemoral TAVR and interventional revascularization of CAS as life-saving rescue therapy in severe AS complicated by CS and cerebrovascular disease (CVD). A combined interventional approach addressing both CVD and valve obstruction enabled procedural safety and favorable recovery, supporting TAVR as a viable option in selected high-risk patients.
PMID:42430181 | DOI:10.1002/ccd.70741