{'fraction_non_alphanumeric': 0.02695829094608342, 'fraction_numerical': 0.003051881993896236, 'mean_word_length': 6.152727272727272, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Disastrous Cholesterol Crystal Embolization After Transcatheter Aortic Valve Replacement

Cholesterol crystal embolization (CCE) can occur after catheter manipulations including percutaneous coronary intervention and endvascular treatment. CCE leads to renal dysfunction and/or blue toe syndrome, and occasionally other systemic embolism. Transfemoral transcatheter aortic valve replacement (TAVR) requires a bulky catheter, and patients receiving TAVR frequently possess multiple atherosclerotic risks; therefore, CCE following TAVR might be underdiagnosed. A 95-year-old male with very severe aortic stenosis was referred to our hospital. He had several comorbidities, including diabetes mellitus, chronic kidney disease, aortic arch aneurysm, peripheral artery disease, old tuberculosis, and interstitial pneumonitis. Despite rich atheroma (Figure 1a), we selected transfemoral TAVR given his lung disease and inappropriate subclavian access. A balloon-expandable valve was deployed via the common femoral artery. Although echocardiography showed favorable valve function, he presented with left hemiplegia, abdominal pain, livedo reticularis, renal dysfunction, and metabolic acidosis. Computed tomography demonstrated cerebral infarction and impaired mesenteric perfusiosn without arterial occlusion (Figure 1c–e). Although he received intensive care including hemodialysis, he died on postoperative day 2. The autopsy revealed ulcerated aortic plaque, and mesenteric and renal infarction with cholesterol crystals (Figure 1b, f–i). Transfemoral approach is the most preferable access, whereas patients with aortic stenosis are known to have more aortic plaques. While atherosclerotic burden is associated with stroke and acute kidney injury following TAVR, reports of CCE have been scarce. Some of these complications after TAVR may be attributed to CCE. In selecting the access route for TAVR, meticulous assessment of aortic plaque should be performed. ORCID