Snare-assisted transcatheter aortic valve implantation: balancing success with risk-a case series

Snare-assisted transcatheter aortic valve implantation (TAVI) has emerged as a bailout technique to facilitate valve delivery in patients with hostile anatomies when standard maneuvers fail. However, while it can increase procedural success, this strategy may also carry significant risks. We present two cases of transfemoral TAVI in patients with severely calcified and tortuous aortic anatomies. In the first case, an 88-year-old woman with severe aortic stenosis and highly tortuous aortic arch underwent successful valve implantation after snare-assisted advancement of the delivery system, achieving optimal hemodynamic and clinical results. In the second case, a 67-year-old woman with porcelain aorta and extensive calcification required snare-assisted delivery of a self-expanding valve after failed conventional maneuvers. Despite successful implantation, the patient developed extensive cerebral embolization with catastrophic neurological sequelae, ultimately leading to death. These cases highlight the double-edged nature of snare-assisted TAVI. While the technique can facilitate valve delivery in anatomically challenging settings, repeated and prolonged device manipulation across a calcified arch may increase the risk of cerebral embolization and other complications. Careful patient selection, use of cerebral embolic protection, and consideration of alternative devices or access routes are crucial to minimize risks.