Department of Neurology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan.
Department of Neurology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan.
J Stroke Cerebrovasc Dis. 2022 Jul;31(7):106525. doi: 10.1016/j.jstrokecerebrovasdis.2022.106525. Epub 2022 Apr 28.
Ischemic stroke is a devastating complication of transcatheter aortic valve implantation (TAVI), mainly occurring in the early postoperative period. The risk of a transplanted heart valve (THV) thrombosis causing stroke may be underestimated in the late postoperative phase. We describe the case of a 92-year-old woman with delayed valve thrombosis causing stroke after TAVI, who developed recurrent strokes eight months after TAVI for severe aortic valve stenosis. Transesophageal echocardiography and cardiac computed tomography revealed a string-like thrombus attached to the implanted valve. With the administration of warfarin, the clot regressed, and the patient was discharged home without recurrence of stroke. Our case demonstrates the importance of THV thrombosis as an embolic source of stroke even in the late postoperative phase and provides a discussion on optimal antithrombotic therapy after TAVI.
缺血性脑卒中是经导管主动脉瓣植入术（TAVI）的一种严重并发症，主要发生在术后早期。在术后晚期，移植物心脏瓣膜（THV）血栓形成导致脑卒中的风险可能被低估。我们描述了一例 92 岁女性患者，在 TAVI 后发生迟发性瓣膜血栓形成导致脑卒中，该患者因严重主动脉瓣狭窄在 TAVI 八个月后再次发生脑卒中。经食管超声心动图和心脏计算机断层扫描显示植入的瓣膜上附着有一条状血栓。给予华法林治疗后，血栓消退，患者出院回家，未再发生脑卒中。我们的病例表明，THV 血栓形成即使在术后晚期也是脑卒中的栓子来源之一，并就 TAVI 后最佳抗血栓治疗进行了讨论。
