Key result
Intracoronary nitroglycerin and PCI successfully resolve rare multivessel vasospasm-induced cardiac arrest during TAVR.
Why the study?
Cardiac arrest during TAVR is an infrequent complication usually attributed to coronary obstruction, but less typical causes such as diffuse multivessel spasm remain poorly recognized.
Case Report (n=1)
Diffuse multivessel spasm, including the left main coronary artery, can precipitate intraprocedural cardiac arrest during TAVR even without typical risk factors, emphasizing the need for prompt recognition and intervention with vasodilators and PCI.
May guide rescue PCI with nitroglycerin for rare vasospasm-induced TAVR arrest; leaves open need for prospective incidence and prevention data.
BACKGROUND: Cardiac arrest during transcatheter aortic valve replacement (TAVR) is an infrequent complication often attributed to coronary obstruction. Causes include sinus sequestration, ostial obstruction by native leaflets or transcatheter valve skirt, and calcium embolization. CASE SUMMARY: An elderly patient with severe aortic stenosis sustained an intraprocedural cardiac arrest due to left main coronary artery spasm with concomitant iliofemoral spasm during TAVR. He was successfully treated with a drug-eluting stent and underwent TAVR 2 days later. DISCUSSION: This case highlights an unusual presentation of diffuse vasospasm involving the left main coronary artery and iliofemoral vessels in the absence of typical risk factors. Prompt recognition of ischemia on cardiac monitoring and percutaneous coronary intervention were essential for survival. TAKE-HOME MESSAGES: Multivessel spasm including in the left main coronary artery can precipitate cardiac arrest during TAVR, even in the absence of traditional risk factors. Recognition and intervention with intracoronary vasodilators and percutaneous coronary intervention are critical for managing vasospasm-related arrest.
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Hakim et al. (2025) conducted a case report in Severe aortic stenosis and intraprocedural cardiac arrest (n=1). Percutaneous coronary intervention and intracoronary nitroglycerin was evaluated. Percutaneous coronary intervention and intracoronary nitroglycerin successfully treated a rare case of multivessel vasospasm-induced cardiac arrest during transcatheter aortic valve replacement.
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