case_images: PMC11804152_01
case_images: Preoperative CT of the patient's aortic root. LCA: left coronary artery; RCA: right coronary artery; SOV: sinus of Valsalva; STJ: sinotubular junction. A: Annulus level short-axis view. The annulus area was 319 mm2, and the valve circumference was 66 mm. B: SOV level short-axis view. The SOV sizes were 27, 28, and 30 mm. C: STJ level short-axis view. The STJ diameter was 23 x 24 mm and was highly calcified. D: Long axis view of aortic root. The LCA height was 19.7 mm, and the RCA height was 13.7 mm. The structure of the aortic valve base was adapted to the 26-mm Evolut pro + device.
case_images: cureus-0017-00000077131-i01.jpg
case_images: PMC11804152_01_cureus-0017-00000077131-i01.jpg
case_images: FIG1
case_images: The sinus of Valsalva (SOV) ranged from 27 to 30 mm, and the sinotubular junction ranged from 23 to 24 mm, with moderate calcification (Figure 1).
case_images: Preoperative enhanced CT of the patient's aortic arch. The arch aorta is slightly shaggy, and a plaque in the wall (arrow) is seen on the arch aorta's greater fold side.
case_images: cureus-0017-00000077131-i02.jpg
case_images: PMC11804152_01_cureus-0017-00000077131-i02.jpg
case_images: FIG2
case_images: However, plaques were found in the aortic arch (Figure 2).
case_images: Magnetic resonance images after TAVR and on the second postoperative day. DWI: diffusion-weighted image; FLAIR: T2-weighted fluid-attenuated inversion recovery image; POD: postoperative day; TAVR: transcatheter aortic valve replacement. A: The post-TAVR images showed no significant changes in both DWI and FLAIR. B: The POD2 images showed high-signal areas along the ischemic region both DWI and FLAIR.
case_images: cureus-0017-00000077131-i03.jpg
case_images: PMC11804152_01_cureus-0017-00000077131-i03.jpg
case_images: FIG3
case_images: Diffusion-weighted imaging (DWI) and T2-weighted fluid-attenuated inversion recovery imaging (FLAIR) showed no significant changes (Figure 3). The next day, the MRI showed enlargement of the infarction area and reappearance of occluded vessels (Figures 3, 4); however, her motor function improved to pre-surgery levels immediately after cerebral reperfusion therapy.
case_images: Magnetic resonance angiography after TAVR and on the second postoperative day. POD: postoperative day; TAVR: transcatheter aortic valve replacement. A: The post-TAVR image. The inferior decision of the left middle cerebral artery disappeared (red arrow). B: The POD2 image. The occluded artery reappeared (yellow arrow).
case_images: cureus-0017-00000077131-i04.jpg
case_images: PMC11804152_01_cureus-0017-00000077131-i04.jpg
case_images: FIG4
case_images: However, magnetic resonance angiography revealed occlusion of the inlet of the left middle cerebral artery (MCA) inferior division (Figure 4). The next day, the MRI showed enlargement of the infarction area and reappearance of occluded vessels (Figures 3, 4); however, her motor function improved to pre-surgery levels immediately after cerebral reperfusion therapy.
case_images: Left internal carotid arteriography before and after the catheter intervention. A: Pre-interventional imaging. The left middle cerebral artery inferior division is occluded at the M2 level (arrow). B: Post-interventional imaging. The occluded vessel has been opened (arrow), and the peripheral side is contrasted.
case_images: cureus-0017-00000077131-i05.jpg
case_images: PMC11804152_01_cureus-0017-00000077131-i05.jpg
case_images: FIG5
case_images: Finally, the left MCA inferior division was completely recanalized (thrombolysis in cerebral infarction scale 3) 3 h and 20 min after the TAVR (Figure 5).
case_images: Computed tomography after reperfusion on the day of surgery. A slight cerebral hemorrhage or contrast accumulation is observed in the ischemic region (arrows).
case_images: cureus-0017-00000077131-i06.jpg
case_images: PMC11804152_01_cureus-0017-00000077131-i06.jpg
case_images: FIG6
case_images: CT after reperfusion on the TAVR day revealed minimal hemorrhage or contrast accumulation in the ischemic region (Figure 6).