Snare-Assisted Management of Nose Cone Entrapment During Self-Expandable Transcatheter Aortic Valve Replacement

Nose cone entrapment is a rare but serious complication of transcatheter aortic valve replacement (TAVR) that requires prompt recognition and management to prevent adverse outcomes. A 77-year-old man with severe aortic stenosis underwent TAVR with a 29-mm Evolut R valve (Medtronic). The nose cone became lodged at the distal stent frame as a result of infolding, caused by a calcified nodule. Standard maneuvers failed, but the complication was successfully resolved using a snare device deployed through contralateral femoral artery access without damage to the prosthesis. Few similar cases have been reported. This case underscores the importance of recognizing risk factors such as severe calcification, significant annular angulation, and large-diameter valves. It also highlights the snare technique as an appropriate, minimally invasive solution for resolving nose cone entrapment. The snare technique is a reliable approach to manage nose cone entrapment during TAVR.