Pitfalls in the diagnosis of post-TAVI (transcatheter aortic valve implantation) stroke

Stroke is an infrequent yet well-known complication of transcatheter aortic valve implantation (TAVI). While mechanical thrombectomy (MT) is a useful rescue procedure in patients with symptomatic post-TAVI stroke, it should be reminded that embolic materials derived from degenerated aortic valve have heterogeneities. We describe a case of post-TAVI stroke in which a calcified debris caused embolic occlusion of the left middle cerebral artery. The calcified embolus eluded detection on magnetic resonance imaging (MRI), which might have been responsible, at least in part, for unsuccessful MT. Formation of calcified debris may not be rare after TAVI, and therefore, brain CT may be given priority as an imaging modality in the initial evaluation of patients suspected of post-TAVI stroke.