Related Experiment Video
Updated: Apr 4, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
A novel approach to extraction of a large thrombus on the intraventricular guide-wire during transcatheter aortic
Thomas Chin1, Padmanabhan Priyesh1, Ashequl M Islam1
1Baystate Medical Center, 759 Chestnut St, Springfield, Massachusetts, 01199.
Insights
Trans-catheter aortic valve replacement (TAVR) can cause guide-wire thrombosis, risking stroke. A novel aspiration thrombectomy technique successfully removed a large thrombus during TAVR, preventing potential neurological events in a high-risk patient.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Trans-catheter aortic valve replacement (TAVR) is a critical option for severe symptomatic aortic stenosis in high-risk patients.
- Guide-wire thrombosis during TAVR is a known complication with potential for embolic events, including stroke.
Observation:
- A large, >1cm thrombus was identified on the intra-ventricular guide-wire during a TAVR procedure using trans-esophageal echocardiogram (TEE).
- Despite thrombus detection, balloon aortic valvuloplasty and valve deployment were successfully completed.
Findings:
- A novel aspiration thrombectomy technique was employed using a guiding catheter and continuous suction.
- The guide-wire and thrombus were safely retrieved as a single unit, preventing embolization.
Implications:
- This case demonstrates a new method for managing guide-wire thrombosis during TAVR.
- Successful thrombus retrieval may reduce the risk of neurological complications, such as stroke, in TAVR patients.
- Further experience with TAVR necessitates strategies to mitigate procedural complications like thrombus formation and embolization.
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 who had open aortic valve replacement (Smith et al. N Engl J Med 2011;364:2187-2198.). This may be related to peri-procedural formation of thrombus and subsequent embolization. We report a case where a large guide-wire thrombus identified during TAVR was successfully removed using a novel approach, preventing a potentially major stroke in this high-risk patient. © 2015 Wiley Periodicals, Inc.
