Case report demonstrates successful aortic valve replacement in severe aortic and vertebral artery stenosis, highlighting the need for individualized blood pressure targets.
Key Points
To describe the clinical management and hemodynamic considerations in a patient with severe aortic stenosis complicated by bilateral vertebral artery stenosis.
Evaluated a 62-year-old woman presenting with recurrent syncope, diplopia, ptosis, and focal weakness using magnetic resonance imaging and hemodynamic assessment.
Implemented individualized blood pressure management and multidisciplinary planning ahead of surgical aortic valve replacement.
Neurologic symptoms were identified as hemodynamic vertebrobasilar hypoperfusion driven by exhausted cerebrovascular reserve rather than embolic stroke, despite normal systemic blood pressure.
Following aortic valve replacement supported by tailored blood pressure targets, the patient experienced complete resolution of syncope and focal neurologic symptoms.