Guide wire thrombus formation during trans-femoral TAVI

摘要

The Amplatz super-stiff (SS) guide wire (Boston Scientific, MA, USA) is commonly used and routinely modified in shape during TAVI. The intention is to form a 'curvature' at the 3.5 cm flexible tip to reduce the risk of left ventricular myocardial perforation during catheter manipulations and valve delivery. We report 2 cases of distal guide wire thrombus formation that occurred on areas of the wire that had been manipulated in shape (Figs. 1 and 2). Both were visualised by intra-procedure TOE and occurred despite an activated clotting time (ACT) greater than 300 seconds prior to wire placement, pre-treatment with dual anti-platelet therapy (aspirin and clopidogrel 75 mg daily) and regular aspiration/flushing of the 18 Fr introducer sheath. Both patients had extensive other co-morbidities, including significant left ventricular systolic dysfunction, and had both been declined surgical aortic valve replacement. The sequence of our trans-femoral TAVI is consistent - we introduce the 18Fr sheath over the SS wire placed in the thoracic aorta, then remove the SS wire, flush the 18Fr sheath side arm and then cross the aortic valve with a catheter (usually AL1), exchange for a pigtail catheter and then position the SS wire through the pigtail catheter (with careful live TOE to check the wire position).