Page 32 - Journal of Structural Heart Disease Volume 3, Issue 3

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Meeting Abstracts
brain parenchyma was still vital. Finally CT-angiography demon- strated an occlusion of the left MCA-bifurcation.
Subsequently systemic thrombolysis with 90mg of Alteplase was ini- tiated. The patient was then transferred to the digital-substraction angiography unit of the Department for Radiology for emergency revascularization. Through a transfemoral access an 8F-balloon- aspiration catheter was placed in the left internal carotid artery (ICA). Digital subtraction angiography (DSA) revealed a persistent occlu- sion (Fig 1a). A 2.3F microcatheter was maneuvered behind the occlu- sion, then a Solitare2-FR 4x20 mm stentretreiver (EV3) was implanted. After 5 minutes the ICA was blocked by the balloon and the stent was retrieved during simultaneous aspiration. A white solid piece of tissue was recovered from the stent (Fig 2). The control angiogram showed a full restauration of blood ow (Fig 1b).
The pathological analysis proved a fragment of the degenerated Hancock II bioprothesis.
After extraction of the embolized material and restauration of a reg- ular cerebral perfusion the patient recovered soon with full sponta- neous awareness. Arti cial ventilation was stopped.
The neurological follow up revealed a complete restitutio ad integrum.
Discussion: Cerebral microembolization is inherent to TAVI, and can occur during all stages of the procedure [6]. The incidence of peripro- cedural manifest stroke is reported to be around 2 - 3% [7,8]. In the majority of cases the embolized material cannot be identi ed. The stroke may be transient, but its impact is often persistent despite sub- sequent thrombolytic and antiplatelet medication.
The intention of this case report is to show that in case of stroke following valve in valve TAVI valve fragments may be the source of embolization requiring an active interventional management of this complication, since fragments cannot be targeted by thrombolytic therapy. Until now we have no data showing the incidence of cere- bral embolizations on the basis of circulating valve fragments. The basis of an active management is an immediate CT angiography of the brain. On the basis of this case report a catheter based intracra- nial diagnostic and active intervention is gaining an important role in the acute management of periprocedural stroke in TAVI [9]. This is in
Figure 1. Digital subtraction angiography. Hijazi, Z
line with new clinical trials demonstrating a better outcome for acute stroke treated with embolectomy compared to thrombolysis [10,11].
As shown in this case a complete regression of stroke can be achieved if the required procedure is done consequently and without time delay.
Considering this case also the routine use of mechanical cerebral pro- tection device to prevent embolization of fragments of the degener- ated implanted valve should be taken into consideration.
Figure 2. Embolized tissue fragment 2 x 2 square mm of the degener- ated Hancock II bioprothesis.
CARDIAC MARKERS IN CHRONIC RENAL FAILURE PATIENTS
Pek JH1, Aw TC2, Lim SH3
1 Department of Emergency Medicine, Sengkang Health,
Singapore
2 Department of Laboratory Medicine, Changi General Hospital,
Singapore
3 Department of Emergency Medicine, Singapore General
Hospital, Singapore
20th Annual PICS/AICS Meeting Abstracts