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Войти в исследования JACC. Case reports · 2026
Femoral-to-Carotid Shunting During Carotid-Access TAVR in Moyamoya-Pattern Vasculopathy.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Mourad Nicolas, Chan Albert W, Tauh Keerit
Аннотация
BACKGROUND: Carotid access is an alternative for transcatheter aortic valve replacement (TAVR) in patients with prohibitive transfemoral anatomy, but it may cause cerebral hypoperfusion with impaired intracranial collateral circulation.
CASE SUMMARY: A 67-year-old woman with symptomatic severe aortic stenosis, extensive comorbidities, and unsuitable transfemoral access underwent TAVR. Neuroimaging demonstrated moyamoya-pattern intracranial vasculopathy with limited collateral reserve. During left carotid exposure, test occlusion caused a >50% decline in cerebral near-infrared spectroscopy despite blood pressure augmentation. A femoral-to-carotid arterial shunt was established to maintain cerebral perfusion. A 26-mm self-expanding Evolut FX+ valve was successfully implanted via left carotid access, with excellent hemodynamics and no neurologic complications.
DISCUSSION: This approach demonstrates a novel cerebral protection strategy for selected patients with compromised cerebrovascular reserve.
TAKE-HOME MESSAGES: Carotid-access TAVR in moyamoya-pattern vasculopathy carries hypoperfusion risk. Real-time near-infrared spectroscopy may detect intolerance to carotid clamping, while femoral-to-carotid shunting may offer cerebral protection.
CASE SUMMARY: A 67-year-old woman with symptomatic severe aortic stenosis, extensive comorbidities, and unsuitable transfemoral access underwent TAVR. Neuroimaging demonstrated moyamoya-pattern intracranial vasculopathy with limited collateral reserve. During left carotid exposure, test occlusion caused a >50% decline in cerebral near-infrared spectroscopy despite blood pressure augmentation. A femoral-to-carotid arterial shunt was established to maintain cerebral perfusion. A 26-mm self-expanding Evolut FX+ valve was successfully implanted via left carotid access, with excellent hemodynamics and no neurologic complications.
DISCUSSION: This approach demonstrates a novel cerebral protection strategy for selected patients with compromised cerebrovascular reserve.
TAKE-HOME MESSAGES: Carotid-access TAVR in moyamoya-pattern vasculopathy carries hypoperfusion risk. Real-time near-infrared spectroscopy may detect intolerance to carotid clamping, while femoral-to-carotid shunting may offer cerebral protection.