Plug-Anchored Coil Embolization of a Paravalvular Aortic Pseudoaneurysm After TAVR With BASILICA

Objective We present a case of aortic pseudoaneurysm after transcatheter aortic valve replacement with BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction), which was tackled with coil embolization with an Amplatzer Vascular Plug II (AVP) acting as an anchor for entanglement. Key Steps The steps were as follows. 1) Obtain bilateral common femoral artery access. 2) Advance 8-F JL 4.5 guide catheter through an Agilis large-curl steerable catheter to engage the aortic pseudoaneurysm adjacent to the left aortic cusp. 3) Deliver the AVP to the pseudoaneurysm while leaving it attached to the delivery cable. 4) Advance an EBU-4.5 6-F guide catheter, then an Excelsior SL-10 microcatheter, to deploy coils into the pseudoaneurysm around the AVP, which acts as an anchor. 5) Deploy multiple coils until resistance is met. 6) Final release of the AVP anchor after sealing the pseudoaneurysm. Potential Pitfalls Coil deployment alone can cause frequent coil prolapse into left ventricle given the high flow state of the pseudoaneurysm. Release of AVP before adequate coil packing of the pseudoaneurysm may result in AVP embolization or pseudoaneurysm rupture. Take-Home Message During coil embolization of a large, high-flow pseudoaneurysm, a vascular plug device can be used as a stabilizing anchor to facilitate controlled coil deployment.