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Background Despite the gold-standard approach for transaortic valve implantation (TAVI) remains transfemoral (TF), alternative approaches are needed in patients who present contraindications to transfemoral access. Case summary We report the case of a 79-year-old female with a symptomatic high gradient severe aortic stenosis - mean gradient of 43 mmHg- and a significant supra-aortic trunk stenosis (left carotid artery: 90-99%; right carotid artery: 50-70 %), and who was hospitalized for progressive dyspnea New York Heart Association (NYHA) stage III. In this high-risk patient, it was decided to perform a transaortic valve implantation (TAVI). Because of a history of stenting of both common iliac arteries in a context of an arterial insufficiency of the lower limbs (Leriche classification stage III) and stenotic thoraco-abdominal aorta atheromatosis, an alternative approach to the transfemoral transaortic valve implantation (TF-TAVI) one was needed. It was decided to perform a combined Transcarotid-TAVI (TC-TAVI) with EDWARDS S3 23 mm valve with a left endarteriectomy during the same operating time. Discussion Our case illustrates an alternative approach to perform a percutaneous aortic valve implantation, despite supra-aortic trunk stenosis, in a high risk surgical patient contraindicated to a TF-TAVI. TC-TAVI remains a safe alternative when transfemoral-TAVI is contraindicated, and the combined approach of CEA and TC-TAVI offers a minimally invasive one-step treatment in high operative risk patients.