Kobayashi Hiroki, Yamada Ryuta, Nomura Yuichi, Oka Naoki, Kokuzawa Jouji, Kaku Yasuhiko
Department of Neurosurgery, Asahi University Hospital, Gifu, Gifu, Japan.
J Neuroendovasc Ther. 2025;19(1). doi: 10.5797/jnet.cr.2025-0021. Epub 2025 Jun 20.
During the perioperative period of carotid artery stenting (CAS), severe aortic stenosis (AS) is associated with a risk of serious complications, such as cardiac arrest. There is no consensus regarding the order of treatment for patients with severe AS concomitant with proximal carotid artery stenosis. We herein report a case in which CAS following transcatheter aortic valve implantation for severe AS was safely performed in an older high-risk patient.
An 84-year-old woman presented with severe aortic stenosis that required treatment. Magnetic resonance angiography revealed severe left proximal internal carotid stenosis. Cerebral blood flow measurements revealed a normal cerebral perfusion. An uneventful transcatheter aortic valve implantation for severe aortic stenosis was followed by carotid stenting at a 2-month interval.
Staged treatment may be a safe and effective strategy in high-risk patients with concomitant severe AS and carotid stenosis. In cases with a normal cerebral blood flow, CAS following transcatheter aortic valve implantation can be a reasonable option, especially in older patients with multiple comorbidities.
在颈动脉支架置入术（CAS）的围手术期，严重主动脉瓣狭窄（AS）与严重并发症风险相关，如心脏骤停。对于合并近端颈动脉狭窄的严重AS患者的治疗顺序尚无共识。我们在此报告一例在老年高危患者中，在经导管主动脉瓣植入术治疗严重AS后安全进行CAS的病例。
一名84岁女性因严重主动脉瓣狭窄需要治疗。磁共振血管造影显示左颈内动脉近端严重狭窄。脑血流测量显示脑灌注正常。在成功进行经导管主动脉瓣植入术治疗严重主动脉瓣狭窄后，间隔2个月进行颈动脉支架置入术。
分期治疗对于合并严重AS和颈动脉狭窄的高危患者可能是一种安全有效的策略。在脑血流正常的情况下，经导管主动脉瓣植入术后进行CAS可能是一个合理的选择，尤其是在患有多种合并症的老年患者中。
