Peri-Procedural Acute Coronary Syndrome During Transcatheter Aortic Valve Replacement

A 76-year-old male with severe chronic kidney disease, porcelain aorta and an oral squamous cell carcinoma (scheduled for chemotherapy and surgical excision) underwent transfemoral aortic valve replacement (TAVR) with a CoreValve Evolut R 34 due to severe aortic stenosis. The percutaneous treatment of a severely calcified stable lesion on ostial left circumflex (LCx) artery was not considered a priority due to the patient's comorbidities and the concerns about dual antiplatelet therapy. However, shortly afterwards valve deployment the patient developed an acute myocardial ischemia on the lateral wall due to LCx artery lesion becoming unstable; it was successfully treated with urgent coronary angioplasty and drug eluting stent implantation. A combination of multiple precipitating factors could be involved in the development of acute coronary syndrome during TAVR procedures.