Intraprocedural Cardiac Arrest and Multivessel Spasm During Transcatheter Aortic Valve Replacement

Cardiac arrest during transcatheter aortic valve replacement (TAVR) is an infrequent complication often attributed to coronary obstruction. Causes include sinus sequestration, ostial obstruction by native leaflets or transcatheter valve skirt, and calcium embolization.

An elderly patient with severe aortic stenosis sustained an intraprocedural cardiac arrest due to left main coronary artery spasm with concomitant iliofemoral spasm during TAVR. He was successfully treated with a drug-eluting stent and underwent TAVR 2 days later.

This case highlights an unusual presentation of diffuse vasospasm involving the left main coronary artery and iliofemoral vessels in the absence of typical risk factors. Prompt recognition of ischemia on cardiac monitoring and percutaneous coronary intervention were essential for survival.

Multivessel spasm including in the left main coronary artery can precipitate cardiac arrest during TAVR, even in the absence of traditional risk factors. Recognition and intervention with intracoronary vasodilators and percutaneous coronary intervention are critical for managing vasospasm-related arrest.