A novel approach to extraction of a large thrombus on the intraventricular guide-wire during transcatheter aortic valve replacement.

Abstract

For appropriate patients with severe symptomatic aortic stenosis with a prohibitively high surgical risk, trans-catheter aortic valve replacement (TAVR) is now established as a viable option. Thrombosis on the intra-ventricular guide-wire during TAVR is a recognized complication (Wiper et al., Cardiovasc Revasc Med 2014). There is an obvious potential for embolization with particular concern for stroke in this situation. We describe a case in which a >1cm thrombus was noted on the intra-ventricular guide-wire by trans-esophageal echocardiogram (TEE) during a TAVR procedure. Balloon aortic valvuloplasty was still performed and an Edwards Sapien valve was deployed. After valve deployment a multi-purpose guiding catheter was advanced with continuous suction. The guide-wire and thrombus were withdrawn inside the guiding catheter. The guide-wire and catheter were removed as a single unit, allowing the thrombus to be safely retrieved. We believe that this is a novel technique of aspiration thrombectomy in this potentially hazardous clinical circumstance. As our experience with TAVR increases, so does our experience with the complications. In the PARTNER trial there was a higher rate of neurological events in TAVR patients than those who had open aortic valve replacement (Smith et al. N Engl J Med 2011;364:2187-2198.). This may be related to peri-procedural formation of thrombus and subsequent embolization. We report a case where a large guide-wire thrombus identified during TAVR was successfully removed using a novel approach, preventing a potentially major stroke in this high-risk patient. © 2015 Wiley Periodicals, Inc.

• Authors: Thomas Chin, Padmanabhan Priyesh, Ashequl M Islam
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 89 Issue 3 Pg. 495-498 (Feb 15 2017) ISSN: 1522-726X [Electronic] United States
• PMID: 26332842 (Publication Type: Case Reports, Video-Audio Media)
• Copyright: © 2015 Wiley Periodicals, Inc.

Topics

• Aged, 80 and over
• Aortic Valve (diagnostic imaging, physiopathology)
• Aortic Valve Stenosis (diagnostic imaging, physiopathology, therapy)
• Balloon Valvuloplasty
• Cardiac Catheterization (adverse effects, instrumentation, methods)
• Cardiac Catheters
• Echocardiography, Transesophageal
• Equipment Design
• Female
• Heart Valve Prosthesis Implantation (adverse effects, instrumentation, methods)
• Humans
• Severity of Illness Index
• Thrombectomy
• Thrombosis (diagnostic imaging, etiology, therapy)
• Treatment Outcome