Key result
Staged transcatheter thrombectomy and TAVR successfully treats concurrent severe AS, acute PE, and GI bleeding.
Why the study?
The concurrent presentation of severe aortic stenosis, acute pulmonary embolism, and gastrointestinal bleeding creates a clinical dilemma where treating one condition may exacerbate another.
Case Report (n=1)
In patients with competing thrombotic and bleeding pathologies, a staged, physiology-first percutaneous approach can enable safe sequential intervention.
Answers are grounded in this paper and cite their sources.
Staged percutaneous management may be feasible in patients with competing thrombotic and bleeding risks; leaves open need for prospective validation.
BACKGROUND: The concurrent presentation of severe aortic stenosis (AS), acute pulmonary embolism (PE), and gastrointestinal bleeding creates a clinical dilemma where treating one condition may exacerbate another. CASE SUMMARY: A 72-year-old woman presented with fatigue, palpitations, and melena. She was found to have severe AS, bilateral acute PE, and a bleeding duodenal ulcer. After initial stabilization with transfusion, we used a staged multidisciplinary approach: catheter-directed thrombectomy with adjunctive balloon angioplasty for residual stenosis, followed by transfemoral transcatheter aortic valve replacement. DISCUSSION: This case illustrates the challenges of coexisting AS, gastrointestinal bleeding, and PE. Although Heyde syndrome was considered a possible unifying mechanism, absent angiodysplasia and von Willebrand factor testing preclude definitive diagnosis. A staged, physiology-driven strategy prioritized immediate threats and enabled safe definitive therapy. TAKE-HOME MESSAGES: In patients with competing thrombotic and bleeding pathologies, a staged, physiology-first approach prioritizing the most immediate threat enables safe sequential intervention. Percutaneous techniques minimize cumulative risk in high-risk patients.
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Wang et al. (2026) conducted a case report in Severe aortic stenosis, acute pulmonary embolism, and gastrointestinal bleeding (n=1). Staged transcatheter approach (catheter-directed thrombectomy, balloon angioplasty, and TAVR) was evaluated. A staged transcatheter approach including thrombectomy, angioplasty, and TAVR successfully managed a patient with concurrent severe aortic stenosis, acute pulmonary embolism, and GI bleeding.
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