Objectives: Here, we present the case of L.B., a 68-year-old Caucasian male patient who reported a sudden onset of right upper limb weakness and transient visual disturbance. Materials and methods: Therefore, he was referred to ER of S. Anna University Hospital of Ferrara. His medical history included moderate aortic valve stenosis due to previous rheumatic heart disease at early age, dyslipid- emia, hypertension and not significant epi-aortic trunks atherosclerosis. Arrived at the Hospital on May 24th 2020, neurological evaluation document- ed just a slight weakness of right upper limb (NIHSS 1); accordingly, he performed urgent brain CT, showing no acute lesions, and he was admitted to the Stroke Unit. A Carotid US was carried out, which showed an iso- hypoechogenic ulcerated plaque with hemodynamic stenosis of 70% at the origin of the left internal carotid artery; patient also underwent echocardiog- raphy, which documented an evolution of the previously known aortic valve stenosis in severe degree stenosis (left ventricular outflow tract diameter 2.3 cm, Aortic valve area 0,87 cm2 ). Results: Considered neurological and instrumental findings, an indi- cation was given for very early carotid TEA, but this was contraindicated for the high operative risk linked to the cardiac condition. Hence, on May 26th 2020, the patient underwent a coronary angiography + balloon percutaneous aortic valvuloplasty (inflation of a 20 ml balloon), as a bridge procedure in order to perform early carotid TEA intervention dur- ing the same day (after a few hours). Discussion and Conclusion: These procedures were carried out with- out complications and the patient had full neurological recovery at dis- charge, one week later. Furthermore, coronary angiography showed a critical stenosis of the middle tract of the LAD with a subcritical stenosis of common trunk. Thus, the patient was listed for a CABG and definitive surgical aortic valve replacement.
Early Combined Percutaneous Aortic Valvuloplasty and Carotid Endarterectomy In A Patient With Minor Ischemic Stroke and High Perioperative Risk
Annibale Antonioni;Nicola Merli;
2020
Abstract
Objectives: Here, we present the case of L.B., a 68-year-old Caucasian male patient who reported a sudden onset of right upper limb weakness and transient visual disturbance. Materials and methods: Therefore, he was referred to ER of S. Anna University Hospital of Ferrara. His medical history included moderate aortic valve stenosis due to previous rheumatic heart disease at early age, dyslipid- emia, hypertension and not significant epi-aortic trunks atherosclerosis. Arrived at the Hospital on May 24th 2020, neurological evaluation document- ed just a slight weakness of right upper limb (NIHSS 1); accordingly, he performed urgent brain CT, showing no acute lesions, and he was admitted to the Stroke Unit. A Carotid US was carried out, which showed an iso- hypoechogenic ulcerated plaque with hemodynamic stenosis of 70% at the origin of the left internal carotid artery; patient also underwent echocardiog- raphy, which documented an evolution of the previously known aortic valve stenosis in severe degree stenosis (left ventricular outflow tract diameter 2.3 cm, Aortic valve area 0,87 cm2 ). Results: Considered neurological and instrumental findings, an indi- cation was given for very early carotid TEA, but this was contraindicated for the high operative risk linked to the cardiac condition. Hence, on May 26th 2020, the patient underwent a coronary angiography + balloon percutaneous aortic valvuloplasty (inflation of a 20 ml balloon), as a bridge procedure in order to perform early carotid TEA intervention dur- ing the same day (after a few hours). Discussion and Conclusion: These procedures were carried out with- out complications and the patient had full neurological recovery at dis- charge, one week later. Furthermore, coronary angiography showed a critical stenosis of the middle tract of the LAD with a subcritical stenosis of common trunk. Thus, the patient was listed for a CABG and definitive surgical aortic valve replacement.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
