Late coronary embolisation after transcatheter aortic valve implantation

An 80-year-old patient with a history of transcatheter aortic valve implantation (TAVI) using a self-expanding valve, ACURATE neo2 M (Boston Scientific), 29 days earlier, presented to the emergency department with lateral ST-segment elevation myocardial infarction (STEMI). It is noteworthy that the coronary angiography performed as part of the pre-TAVI work-up showed no significant stenosis (Moving image 1), and the pre-TAVI CT analysis (Figure 1A-Figure 1B-Figure 1C-Figure 1D) revealed a virtual transcatheter heart valve (THV)-to-left coronary ostial distance of 5.8 mm (Figure 1D), indicating a low risk of coronary obstruction. Additionally, aortography performed after TAVI demonstrated the absence of any coronary obstruction (Moving image 2).

Urgent coronary angiography revealed an acute occlusion at the level of the proximal left circumflex artery (Figure 1E, Moving image 3). The door-to-wire time was 23 minutes. Thrombectomy with the Indigo System CAT RX catheter (Penumbra) was performed with two aspiration passages across the occlusion (Moving image 4), resulting in the immediate restoration of a distal Thrombolysis...