The Amplatz super-stiff (SS) guide wire (Boston Scientific, MA, USA) is commonly used and routinely modified in shape during TAVI. The intention is to form a ‘curvature’ at the 3.5 cm flexible tip to reduce the risk of left ventricular myocardial perforation during catheter manipulations and valve delivery. We report 2 cases of distal guide wire thrombus formation that occurred on areas of the wire that had been manipulated in shape ( Figs. 1 and 2 ). Both were visualised by intra-procedure TOE and occurred despite an activated clotting time (ACT) greater than 300 seconds prior to wire placement, pre-treatment with dual anti-platelet therapy (aspirin and clopidogrel 75 mg daily) and regular aspiration/flushing of the 18 Fr introducer sheath.
