Author + information
- Received March 20, 2018
- Accepted March 27, 2018
- Published online June 13, 2018.
- Victor Alfonso Jimenez Diaz, MD, MPHa,b,∗ (, )
- Jose Antonio Baz Alonso, MDa,
- Oscar Estevez Ojea, Biolb,
- Alexandre Serantes Combo, MDc,
- Carlos Manuel Rodriguez Paz, MDd and
- Andres Iñiguez Romo, MD, PhDa
- aInterventional Cardiology Unit, Department of Cardiology, Hospital Alvaro Cunqueiro, University Hospital of Vigo, Vigo, Spain
- bCardiovascular Research Unit, Department of Cardiology, Hospital Alvaro Cunqueiro, University Hospital of Vigo, Vigo, Spain
- cDepartment of Pathology, Hospital Alvaro Cunqueiro, University Hospital of Vigo, Vigo, Spain
- dNeuroradiology Unit, Department of Radiology, Hospital Alvaro Cunqueiro, University Hospital of Vigo, Vigo, Spain
- ↵∗Address for correspondence:
Dr. Victor Alfonso Jimenez Diaz, Hemodynamics & Interventional Cardiology Unit, Cardiology Department, Hospital Alvaro Cunqueiro, University Hospital of Vigo, Estrada Clara Campoamor 341, 36312 Vigo, Spain.
A 77-year-old man with a history of severe chronic obstructive pulmonary disease and severe symptomatic aortic stenosis was admitted for transfemoral transcatheter aortic valve replacement with a 31-mm self-expandable valve (CoreValve Evolut R, Medtronic, Minneapolis, Minnesota). Real-time continuous monitoring of blood flow velocity with transcranial Doppler ultrasonography (WAKIe-2TC, Atys Medical, Soucieu-en-Jarrest, France) was performed during the procedure. First, balloon aortic valvuloplasty, with a 20-mm balloon, was performed. After balloon aortic valvuloplasty but before valve implantation, an abrupt interruption of the blood flow velocity in the left middle cerebral artery (LMCA) was detected, with normal flow maintained in the contralateral artery (Figure 1A, Online Video 1). Cerebral arteriography showed acute thrombotic occlusion of the LMCA (Figure 1B, Online Video 2). The thrombus (Figure 1C), consisting of accumulations of fibrin, platelets (Figure 1C inset, arrowhead) and erythrocytes (Figure 1C inset, arrow), was successfully retrieved with a SOLITAIRE 26 × 30 mm (Covidien, Irvine, California) stent retriever, thereby restoring LMCA blood flow (Figure 1D, Online Video 3). The patient’s symptoms were rapidly reversed. Magnetic resonance imaging at 3-month follow-up showed a large cerebral infarction in the LMCA territory (Figure 1E). At 6-month follow-up, hemiparesis recovered completely, with mild dysphasia remaining.
Stroke during transcatheter valve interventions is a potentially devastating complication. Mechanical thrombectomy could be an effective treatment method. Optimal periprocedural antithrombotic management (1) is essential, and embolic protection devices should be considered in high-risk populations (2). Close collaboration between interventional cardiologists and the stroke care team is advisable to establish an early management plan and minimize brain damage.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 20, 2018.
- Accepted March 27, 2018.
- 2018 American College of Cardiology Foundation
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