Left main thrombotic occlusion following balloon aortic valvuloplasty for severe aortic stenosis

Percutaneous balloon aortic valvuloplasty is used in high-risk patients with significant aortic stenosis, either as palliation or as a bridge to more definitive treatment. We report the case of a high-risk patient, a man aged 71 years and with multiple comorbidities, undergoing this procedure. Following the procedure, he was given protamine to aid with vascular closure. This immediately led to hemodynamic collapse and cardiopulmonary arrest with angiographic evidence of thrombus occluding the left main coronary artery. This extremely rare complication requires prompt and aggressive treatment to enable good functional recovery of the individual.