As the world population ages, especially in Western countries, the prevalence of aortic stenosis only increases. Similarly, the indications for TAVR become more and more permissive, and the procedure is gaining more ground on surgical replacement of the aortic valve, with patients with increasingly more comorbidities, including severe peripheral vascular disease, being referred for TAVR. Therefore, the invasive cardiologist will inevitably be increasingly more confronted to the situation of alternate or non-femoral access for TAVR [ ]. In recent years, trans-carotid TAVR has gained more and more popularity as an alternative access to the femoral one for patients with ilio-femoral or descending aortic anatomy at high risk for vascular complications. However, robust data comparing the safety of this technique to the trans-femoral route or other alternate access is still lacking.