A Case of Urgent Carotid Artery Stenting for Repeated Transient Ischemic Attack Caused by Complete Atrioventricular Block after Transcatheter Aortic Valve Replacement

Abstract

Objective: A patient with symptomatic carotid artery stenosis (SCAS), complicated with symptomatic severe aortic stenosis (SSAS) had frequent transient ischemic attacks (TIAs) caused by complete atrioventricular block (AV block) after transcatheter aortic valve replacement (TAVR). After TAVR, the patient required urgent carotid artery stenting (CAS) as a result of the hemodynamic changes induced by an AV block and the analysis of the morphological and functional events after treatment in such cases is presented.

Case Presentation: An elderly patient with combined SCAS and SSAS was scheduled by endovascular intervention. Initially, TAVR was performed, however an AV block developed, followed by frequent TIAs. CAS and permanent pacemaker placement were performed to prevent further TIAs or stroke. After the CAS was required management for cerebral hyperperfusion syndrome (CHS), but risks of fatal asystole or acute heart failure with bradycardia and hypotension while expanding the stenotic carotid lesion was avoided.

Conclusion: Regarding the case of SCAS complicated with SSAS, TAVR to precede CAS could become one of the treatment options.