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

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
Thomas ChinAshequl M Islam

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 The guide-wire and thrombus were withdrawn inside the guiding catheter.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 ...Continue Reading

References

Jun 7, 2011·The New England Journal of Medicine·Craig R SmithUNKNOWN PARTNER Trial Investigators
May 9, 2013·Circulation·Nicolas M Van MieghemPeter P de Jaegere
May 13, 2014·Cardiovascular Revascularization Medicine : Including Molecular Interventions·Andrew WiperDavid Roberts

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Citations

Feb 27, 2019·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Megan A JamiolkowskiQijin Lu

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