Systemic Thrombolytic Therapy for Stroke After Transcaval Transcatheter Aortic Valve Replacement

An 80-year-old male with aortic stenosis underwent transcatheter aortic valve replacement through a transcaval approach. The aorta was closed with an Amplatzer device without retroperitoneal leak or fistula. The patient developed a stroke three hours after the procedure and was treated with tissue plasminogen activator. Imaging after thrombolytic therapy revealed no aortic extravasation from the puncture site. To our knowledge, this demonstrates the first case in which thrombolytic therapy was used after transcaval access to the abdominal aorta for transcatheter aortic valve replacement and suggests that patients without leak after transcaval aortic closure, thrombolytic therapy is not contraindicated.