Embolization to Two Different Vascular Territories in a Patient With Bicuspid Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation.

We describe the case of an 81-year-old man with symptomatic severe bicuspid aortic valve stenosis. Transfemoral transcatheter aortic valve implantation was performed with a cerebral embolic protection device. During valve deployment, the 29-mm Evolut PRO prosthesis (Medtronic) popped out 3 times and exchanged for a 34-mm Evolut R. Large valvular debris were captured in the embolic protection device. Subsequently, the patient developed chest pain and electrocardiogram modification. An emergency coronary angiography showed an occlusion of the middle circumflex artery. This case demonstrates technical challenges and possible complications in patients with bicuspid aortic valve stenosis undergoing transcatheter aortic valve implantation.