Recurrent strokes after transcatheter aortic valve replacement in an elderly patient with severe bicuspid aortic...

Transcatheter aortic valve replacement (TAVR) has evolved from a novel technology to an established therapy for high-risk patients with symptomatic severe aortic valve stenosis (AS). Recently, its use has also been extended to low-risk patients, resulting in its increasing utilization in patients with bicuspid aortic valve (BAV). But as a serious post-TAVR complication, ischemic stroke was associated with a nearly 6-fold increased 30-day mortality. BAV presents unique challenges for post-TAVR antithrombotic therapy due to its distinct valvular anatomy.

We present a case of a 72-year-old female who presented with angina pectoris symptoms and was found to have severe BAV stenosis (Type 0). According to the patient's age, obvious symptom and willingness herself, TAVR was successful performed with deployment of a 23 mm Venus-A Plus valve (Venus Medtech, Hangzhou, China). A post-procedure echocardiogram confirmed the appropriate placement of the bioprosthetic valve with minor paravalvular regurgitation. Six months after TAVR, this patient experienced multiple strokes, presenting a significant challenge for clinicians.

This case underscores the serious complications that can occur post-TAVR and highlights the need for improved strategies to prevent early strokes.