Guide Extension-Assisted Stent Implantation at Ostial Right Coronary Artery Creating Stent Tunnel During...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Coronary artery occlusion is a rare but serious complication following transcatheter aortic valve replacement (TAVR).
• Risk factors include low coronary artery height and specific bioprosthesis designs.
• Preventive strategies are crucial for patient safety during TAVR procedures.

Observation:

• An 86-year-old female patient presented with a failed surgical bioprosthesis, requiring simultaneous TAVR and percutaneous coronary intervention (PCI) for an obstructive ostial right coronary artery (RCA) lesion.
• The patient had low coronary ostial heights, increasing the risk of coronary occlusion.
• Suprannular valve expansion after post-dilation compromised the RCA ostium.

Findings:

• A novel stent tunnel technique was successfully employed to maintain antegrade flow in the RCA.
• The stent tunnel was created by advancing a stent under the native aortic valve leaflets towards the left coronary sinus.
• This innovative approach ensured continued RCA perfusion despite ostial compromise.

Implications:

• This case highlights a successful strategy for managing coronary ostial compromise during complex TAVR procedures.
• The stent tunnel technique offers a potential solution for patients with challenging coronary anatomy and TAVR.
• Further research may explore the broader applicability of this technique in preventing TAVR-related coronary artery occlusion.