Successful Mechanical Aspiration of Embolized Vessel Fragment During TAVR With Penumbra Indigo Cat Rx Catheter

J INVASIVE CARDIOL 2021;33(4):E315. 

Key words: aortic valve stenosis, aspiration catheter, cardiac imaging

An 81-year-old female with severe aortic valve stenosis underwent transcatheter aortic valve replacement (TAVR) using the right femoral approach. The right common femoral artery minimum diameter was 5.6 mm. A 29 mm Evolut Pro valve (Medtronic) was deployed successfully. Shortly after deployment, the patient became hypotensive and ST depressions were noted on telemetry. A transthoracic echocardiogram (TTE) revealed anteroseptal and anterior hypokinesis (Video 1). Ascending aortography via left radial artery revealed patent coronary ostia and no aortic dissection. Selective left coronary angiography revealed coronary embolism to the left anterior descending (LAD)/first diagonal bifurcation (Video 2). We elected to perform aspiration thrombectomy. An Indigo Cat Rx aspiration catheter (Penumbra) was advanced to the mid LAD, where mechanical aspiration was performed. Upon flushing the aspiration catheter, a small piece of debris was retrieved (Figures 1A and 1B). The final angiogram is shown in Video 3. TTE revealed normalization of wall motion (Video 4). The 2 previously placed Perclose Proglide devices were deployed with complete hemostasis in the right groin. Iliofemoral angiography was normal. Pathology showed the retrieved material to be a fragment of a small- or medium-sized blood vessel (Figures 1C and 1D). We believe it was a broken-off fragment of the femoral artery that migrated on the tip of the TAVR delivery system. This is the first reported case of such a complication. By using this mechanical aspiration strategy, we not only successfully treated this complication but also avoided the need for coronary stent deployment. The patient is doing well at 4-month follow-up and free from adverse cardiac events.

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From the ¹Department of Cardiovascular Medicine, ²Department of Pathology, and ³Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted April 15, 2020.

Address for correspondence: Shazib Sagheer, MD, Tinsley Harrison Tower, Suite 311, 1900 University Boulevard, Birmingham, AL 35233. Email: Shazibcheema@gmail.com