Staged Versus Concomitant Carotid Endarterectomy and Aortic Valve Replacement: A Case Report and Literature Review

Abstract

Stroke is a common complication of cardiac surgery, and carotid artery stenosis is an established risk factor for stroke. Therefore, patients with carotid artery stenosis who are undergoing cardiac surgery require proper management of the former either simultaneously or before cardiac surgery. We present a challenging case of a 67-year-old male patient who presented with generalized weakness, severe aortic stenosis, and significant bilateral carotid artery stenosis. The coexistence of these findings sparked a debate about whether to perform a carotid endarterectomy first or an aortic valve replacement. Moreover, a past history of percutaneous coronary intervention and coronary artery bypass grafts made the decision more challenging. Multiple approaches have been employed for the management of coexisting carotid artery stenosis with cardiac surgery; however, no definitive guidelines exist, especially for surgeries other than coronary artery bypass grafts or where the carotid stenosis is bilateral and severe.

Keywords: aortic valve surgery; bilateral internal carotid artery stenosis; cardiac valvular surgery; carotid artery stenting (cas); carotid endarterectomy (cea); combined cardiac surgery; coronary artery bypass grafting(cabg); perioperative stroke; severe asymptomatic aortic stenosis; tavr( transcatheter aortic valve replacement).

Figure 1. CT angiography illustrating severe bilateral carotid artery stenosis