Key result
Ipsilateral carotid snare stabilization enables successful transcarotid TAVI bailout with a post-procedure gradient of 6 mmHg.
Why the study?
Does an additional small-bore ipsilateral carotid access route enable safe snare control of an embolized self-expanding valve while preserving the left ventricular guidewire rail for second-valve delivery during transcarotid TAVI?
Case Report (n=1)
No
Does an additional small-bore ipsilateral carotid access route enable safe snare control of an embolized self-expanding valve while preserving the left ventricular guidewire rail for second-valve delivery during transcarotid TAVI?
In surgically exposed transcarotid TAVI complicated by valve embolization into the ascending aorta, placing an additional small-bore sheath in the ipsilateral carotid artery provides a direct, independent route for snare stabilization while preserving the left ventricular wire rail for second-valve delivery.
Answers are grounded in this paper and cite their sources.
Offers bailout option for embolization in transcarotid TAVI; extends technical approaches but remains hypothesis-generating.
Objective: Transcatheter heart valve embolization and migration are rare but potentially catastrophic. During transcarotid transcatheter aortic valve implantation, rescue is challenging because the principal carotid access must preserve the left ventricular rail for 2nd-valve delivery. Case Presentation: An 81-year-old man receiving maintenance hemodialysis had symptomatic severe aortic stenosis and aortic calcification precluding transfemoral valve delivery. A 26-mm Evolut FX+ valve (Medtronic, Minneapolis, MN, USA) was implanted through a surgically exposed left common carotid artery (CCA). Immediately after final release, the valve popped into the ascending aorta and caused severe aortic regurgitation. With the left ventricular wire maintained, the 18-Fr DrySeal sheath (W. L. Gore & Associates, Flagstaff, AZ, USA) was removed, the proximal CCA was clamped, and a purse-string suture was placed proximal to the original puncture. A separate 6-Fr sheath was inserted through the purse-string, and a 35-mm Amplatz Goose Neck snare (Medtronic) captured the recapture tab, enabling controlled stabilization of the embolized valve in the ascending aorta. The principal access was then converted to the Evolut InLine sheath, and a 2nd 26-mm valve was implanted successfully under continued snare control. No neurological deficit occurred. Echocardiography showed a mean gradient of 6 mmHg with trivial paravalvular leakage; computed tomography showed both valves without aortic wall injury or leaflet thrombosis. Conclusion: In surgically controlled transcarotid procedures, an additional small-bore ipsilateral carotid route can enable snare control of a mobile embolized valve while maintaining the left ventricular guidewire rail for 2nd-valve delivery. This strategy requires direct carotid control and careful assessment of cerebral perfusion, carotid integrity, arch-branch patency, and the ectopic frame–aortic wall relationship.
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Sai et al. (2026) conducted a case report in Symptomatic severe aortic stenosis complicated by aortic pop-up embolization during transcarotid TAVI (n=1). Bailout snare stabilization via an additional 6-Fr sheath placed in the surgically exposed ipsilateral left common carotid artery followed by second 26-mm Evolut FX+ valve implantation was evaluated on Successful stabilization of the embolized valve and implantation of a second transcatheter heart valve without neurological deficit or aortic wall injury. Snare stabilization via an additional 6-Fr ipsilateral carotid sheath enabled second 26-mm valve implantation with a post-procedure mean gradient of 6 mmHg and no neurological deficit.
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