Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
A 85 year-old gentleman who had a history of stroke and hemiplegia was admitted with dyspnea on exertion. He had a history of stroke at seventy two years old and post operative stomach cancer, chronic obstructive plumonary disease, hypertension, diabete mellitus, and chronic renal failure. Transthoracic echocardiography showed low flow low gradient aortic valve stenosis with low LV systolic function (EF=37.0%, AVA=0.74 cm2). His STS score was 10.5, and logistic EuroSCORE was 53.0%.
Relevant test results prior to catheterization
The transthoracic echocardiography showed low flow low gradient severe degenerative AV stenosis with low LV systolic function (EF=37%). AV peak verocity was 4.1 m/sec and peak pressure gradient was 61.3 mmHg, mean pressure gradient was 32.4 mmHg. Aortic valve area by continuity equation was 0.74 cm2.
Relevant catheterization findings
Preoperative coronary angiography showed no significant stenosis.
The MRA showed occlusion of a left internal carotid artery with collateral flow from a left vertebral artery and a right carotid artery stenosis. CT showed 501.5 cm2 annulus area and severe stenosis of both of iliofemoral arteries. We planned to proceed TAVI from a TA approach with protection of a right brachiocephalic artery and a left vertebral artery. First of all, we protected a left subclavian artery using a Parachute 12 x 20 mm balloon. And then, we protected a right brachiocephalic artery using a Parachute 15 x 20 mm balloon. At last, we deployed 26 mm Sapien XT valve from a TA approach. Two weeks later after the procedure, he was discharged from the hospital without any stroke event.
We experienced a severe high risk of stroke TAVI case. And we could success a procedure without any symptomatic stroke using a protection device. Our precious case may be a good example for one of a technique of prevention of a stroke.