Mechanical Thrombectomy for Cerebral Embolism after Transcatheter Aortic Valve Replacement: A Case Report.

Objective: Cerebral infarction is a major perioperative complication of transcatheter aortic valve replacement (TAVR). The number of patients undergoing TAVR has been increased annually. Therefore, neurosurgeons and neurologists who engage in stroke therapy, including mechanical thrombectomy (MT), may have more opportunities to treat stroke patients after TAVR in the future. We herein report a case of MT that was performed for cerebral infarction after TAVR.

Case presentation: A 92-year-old woman presented with right upper extremity weakness 1 day after undergoing TAVR. On diffusion-weight MRI, most regions of the left middle cerebral artery (MCA) showed a high signal intensity due to the occlusion of the left MCA. She was diagnosed with cerebral infarction due to left M2 occlusion and underwent MT using a stent retrieval and aspiration device under proximal flow arrest using a balloon guide catheter. After thrombectomy, angiography revealed thrombolysis in cerebral infarction (TICI) 3 revascularization. Histopathological analysis of the retrieved embolus revealed vascular endothelial cells surrounding a portion of the tissue and an interstitium composed of fibrotic tissue without any atheromatous lesions. The embolus was believed to consist of part of the valve tissue because an atheromatous lesion was not formed in the valve tissue, and no smooth muscle-rich media were observed, unlike in the artery wall.

Conclusion: Cerebral embolism after TAVR can be caused by emboli from valve tissue. In such cases, MT using a combined technique with proximal flow arrest may be effective.