Anesthetic and procedural strategy for coexisting severe aortic stenosis and carotid artery stenosis: A case report

BACKGROUND Aortic stenosis (AS) often coexists with carotid artery stenosis. However, clear guidelines for the optimal treatment strategy and sequencing of interventions in patients with both conditions are lacking. CASE SUMMARY A 79-year-old man with a history of hypertension presented with right-sided paralysis and pain. Magnetic resonance imaging revealed multiple infarctions in the left cerebral hemisphere and severe stenosis of the left carotid artery. Transthoracic echocardiography also identified coexisting severe AS. Carotid artery stenosis increases the risk of stroke during aortic valve manipulation; therefore, carotid intervention may be recommended prior to aortic valve treatment. However, perioperative hypotension and bradycardia associated with carotid intervention can precipitate circulatory collapse in patients with severe AS. After a multidisciplinary conference, the decision was made to first perform transcatheter aortic valve implantation under general anesthesia, followed by carotid endarterectomy 4 months later. Both procedures were completed successfully without complications. CONCLUSION Treatment strategy should be individualized, balancing perioperative risks and benefits in patients with severe AS and carotid artery stenosis.