Increase carotid flow by double sheath connection technique to reduce cerebral ischemia for transcatheter aortic valve implantation through transcarotid approach

Purpose: Transcarotid transcatheter aortic valve implantation (TAVI) is one alternative approach if unfavorable femoral access. However, this approach may cause cerebral vascular accidents (CVAs) by temporarily occluding common carotid artery (CCA). The purpose of this study is to develop a new method reducing cerebral ischemia during transcarotid TAVI. Methods: We inserted an 8-and 18-Fr. sheath in CCA with tip toward brain and aortic arch, respectively, and connected their side arms to create a bypass flow. Medtronic Cor-eValve was then delivered and deployed in position after pre-TAVI balloon dilatation. Results: Three patients received this implantation. There were no CVAs or transient ischemic attacks (TIAs) after the procedure and all patients had been followed up uneventfully for 1 year. Conclusion: Our technique is feasible and potentially reduces stroke in transcarotid TAVI.