# Transcarotid transcatheter aortic valve replacement combined with percutaneous coronary intervention for severe aortic stenosis with coronary artery disease in a tortuous aortic arch: a Case Report

## TL;DR

A patient with severe aortic stenosis and coronary artery disease successfully underwent transcarotid TAVR and PCI due to a tortuous aortic arch.

## Contribution

This is the first reported case combining transcarotid TAVR and PCI in a patient with a tortuous aortic arch.

## Key findings

- Transcarotid TAVR and PCI were successfully performed in a patient with a Z-shaped tortuous aortic arch.
- The patient recovered well, ambulating the next day and being discharged on the fifth postoperative day.
- No prior reports of this combined procedure have been published.

## Abstract

Transcatheter Aortic Valve Replacement (TAVR) is currently the preferred treatment option not only for high-surgical-risk patients with severe aortic stenosis (AS) but also increasingly for those with intermediate and low surgical risk. Coronary artery disease (CAD) is one of the most common complications in severe AS patients, making percutaneous coronary intervention (PCI) a frequent clinical requirement in cases of severe AS complicated by CAD. The coexistence of Aortic Tortuosity and aortic stenosis is extremely rare.We report a case of an elderly male with severe aortic stenosis combined with coronary artery disease, who underwent successful transcarotid TAVR and PCI due to a Z-shaped fold tortuosity in the aortic arch, making femoral access challenging. The patient was able to ambulate the following day and was discharged on the fifth postoperative day with stable follow-up. As of this writing, no related reports of combined transcarotid TAVR and PCI have been published.