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Updated: Feb 9, 2026

Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Procedural challenge of coronary catheterization for ST-segment elevation myocardial infarction in patient who
Yukio Aikawa1, Yu Kataoka2, Tomoaki Kanaya3
1Department of Cardiovascular Medicine, Hokusetsu General Hospital, Takatsuki, Japan.
Insights
Transcatheter aortic valve replacement (TAVR) with CoreValve can complicate subsequent coronary angiography. Careful catheter manipulation strategies are essential for percutaneous coronary intervention (PCI) in TAVR patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Transcatheter aortic valve replacement (TAVR) is a common procedure for severe aortic stenosis.
- Prosthetic valve implantation can present challenges for future cardiac interventions.
- Coronary angiography is crucial for diagnosing and treating acute coronary syndromes.
Abstract:
A 73-year-old man with severe aortic valve stenosis successfully underwent transcatheter aortic valve replacement (TAVR) using CoreValveTM (29 mm, Medtronic Inc., Minneapolis, MN, USA). Four years after the TAVR, he was hospitalized due to anterior ST-segment elevation myocardial infarction. Despite the need for prompt restoration of coronary flow in the infarct-related artery, the implanted CoreValveTM profoundly restricted the manipulation of diagnostic catheters during the coronary angiography. In particular, (I) guidewire easily migrated into the space between CoreValveTM and aorta vessel wall; (II) the nickel-titanium frame of CoreValveTM limited the space to manipulate catheters, making difficult to advance Judkins left (JL) 4, Judkins right (JR) 4 and Amplatz left 1 into coronary cusps; and (III) selecting specific spot within frame was required for cannulation. Left and right coronary arteries were barely engaged by JL3.5 and modified JR4, respectively. Percutaneous coronary intervention (PCI) for culprit lesion in the left-anterior descending artery was successfully completed by 6-French JL3.5 (BritetipTM, Cordis, Milpitas, CA, USA) with drug-eluting stent implantation. Meticulous strategies and understanding of the prosthetic valve geometry are warranted to conduct PCI in patients who underwent TAVR.
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