Acute ischemic stroke during TAVI promptly managed with mechanical thrombectomy: the importance of peripheral interventional skills and multidisciplinary collaboration.

UNLABELLED: Transcatheter aortic valve implantation (TAVI) carries a small but serious risk of periprocedural stroke. Prompt recognition and rapid management are essential to prevent permanent neurological injury. We describe an acute ischemic stroke occurring during TAVI for bicuspid aortic stenosis, immediately identified by the interventional cardiologist through carotid angiography. The patient developed sudden left hemibody weakness and aphasia after balloon predilatation, and angiography revealed an occlusion of the right middle cerebral artery (M1). While maintaining hemodynamic stability with valve implantation, the operator restored partial flow in the ophthalmic artery and activated the stroke team. Mechanical thrombectomy was rapidly performed using an aspiration catheter, achieving complete recanalization, with a modified Thrombolysis in Cerebral Infarction grade 3 within 30 min of symptom onset. Post-procedural imaging confirmed the absence of hemorrhage, and neurological deficits improved markedly. This case highlights how immediate in-laboratory carotid angiography performed by the structural interventional cardiologist can significantly shorten the diagnostic-to-reperfusion interval and facilitate ultra-rapid multidisciplinary rescue in periprocedural stroke.

LEARNING OBJECTIVE: Immediate in-laboratory carotid angiography by the structural operator may significantly shorten time-to-reperfusion in periprocedural stroke. Peripheral interventional skills are essential for structural cardiologists, enabling them to promptly recognize and address extracardiac complications. Multidisciplinary collaboration between interventional cardiologists, neurologists, and interventional radiologists is vital to achieve optimal outcomes in life-threatening complications. The absence of cerebral embolic protection did not compromise the outcome, consistent with recent randomized evidence showing no significant reduction in clinical stroke with routine use of protection devices.