Transfemoral Intracardiac Echocardiography-Guided Transcarotid Transcatheter Aortic Valve Replacement

Objective: Transcarotid transcatheter aortic valve replacement (TAVR) is increasingly being performed in patients with unfavorable anatomy for the transfemoral approach. Although transesophageal echocardiography (TEE) is commonly used for intraprocedural guidance during transcarotid TAVR, TEE may not be feasible in certain clinical scenarios. In such cases, an alternative intraprocedural imaging modality is required. Case Presentation: An 88-year-old woman with symptomatic severe aortic stenosis and severe tortuosity of the descending and abdominal aorta underwent transcarotid TAVR. Intraprocedural guidance was provided by transfemoral intracardiac echocardiography (ICE). Transfemoral ICE was used for echocardiographic assessment before and after valve deployment, with the catheter manipulated from a position away from the operative field. The procedure was successfully completed without complications. Conclusion: This report describes the feasibility of transfemoral ICE-guided transcarotid TAVR. While TEE remains the standard imaging modality for transcarotid TAVR, transfemoral ICE may be considered as a feasible alternative in selected clinical scenarios in which TEE is not feasible.