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An 81-year-old man was referred to our hospital with increasing dyspnea and angina pectoris for several months. The patient also had a prior history of peripheral arterial disease, which had been treated with two 8 mm stent in both iliac arteries.

Transthoracic echocardiography confirmed severe aortic stenosis (mean aortic valve pressure gradient: 34 mmHg, aortic valve area: 0.9 cm²). Preoperative cardiac computed tomography showed a severely calcified aortic valve with a perimeter-derived annulus diameter of 27.4 mm. Furthermore, the computed tomography showed the incomplete stent apposition in the right iliac artery, confirmed by the lack of contact between the stent and the arterial wall (Image 1).

The internal heart team decided to perform a transfemoral transcatheter aortic valve replacement (TAVR) via the right femoral artery. After dilatating the femoral access using an 18Fr Medtronic sheath, we advanced a 34 mm Evolut Pro+ system. Hereafter, it turned out that the iliac stent was migrated along with the delivery system (Image 2). While we retracted the Evolut system, the iliac stent was left in the aortic arch. 
Stent left.mp4

The inline Evolut R system was exchanged for an 18Fr 30 cm Check-Flo sheath. We advanced an 11Fr 75 cm sheath as a mother-child technique to obligate catching the dislocated stent, followed by a 20 mm Snare System through the Confida wire on which the iliac stent was located. The wire of the Snare System was detached from its catheter shaft while pulling the system back to the guiding catheter. With a second 20 mm Snare System supported by the 11Fr 75 cm-sheath, the iliac stent was successfully extracted from the body through the 18Fr sheath (Image 3). 
snaring.mp4

TAVR was successfully performed with no hemodynamic instability or bleeding in the access route). Our report describes an instance of iliac stent migration during transfemoral TAVR and its successful retrieval with a Snare supported by the mother-child technique.