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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present a 73-year-old man with severe aortic stenosis &#40;area 0&#46;6 cm<span class="elsevierStyleSup">2</span>&#41; and left ventricular dysfunction in New York Heart Association class III&#46; He had a previous history of hypertension&#44; peripheral vascular disease&#44; chronic obstructive pulmonary disease and porcelain aorta&#46; His logistic EuroSCORE was 20&#46;01&#37; and Society of Thoracic Surgeons score was 2&#46;78&#37;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">After careful evaluation by the heart team&#44; the patient was referred for transcatheter aortic valve implantation &#40;TAVI&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Femoral and left subclavian routes were not suitable for the procedure due to calcified and severe stenoses&#46; Other routes were also rejected&#44; the right subclavian artery due to aortic annulus angulation &#40;&#62;60&#176;&#41; and direct aortic access due to porcelain aorta &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; The minimum diameter of the left common carotid artery was 6&#46;3 mm&#44; so TAVI was scheduled&#46; Cerebral magnetic resonance angiography was carried out to confirm the presence of collateral perfusion through the circle of Willis&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The procedure was performed in the catheterization laboratory&#44; the team members being specially positioned for this approach &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46; The proximal left common carotid artery was exposed under general anesthesia&#46; Thereafter&#44; sequential dilation of the carotid artery was performed and an 18F vascular access sheath was carefully advanced into the ascending aorta&#46; The valve delivery system was then advanced and a 29 mm CoreValve Evolut R self-expanding prosthetic valve was successfully deployed&#46; There was no residual gradient or significant aortic regurgitation &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#44; <a class="elsevierStyleCrossRef" href="#sec0035">Video 1</a>&#41;&#46; The patient was discharged five days after the procedure without complications&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">A transcarotid approach represents an alternative access route for TAVI in selected cases with no other suitable vascular approach&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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