Coming down the "chimney": Percutaneous coronary intervention on a post-transcatheter aortic valve replacement with...

Area of Science:

• Interventional Cardiology
• Cardiovascular Imaging
• Structural Heart Disease

Background:

• Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
• Post-TAVR coronary access can be challenging due to valve implantation and surrounding structures.
• Percutaneous coronary intervention (PCI) may be necessary in TAVR patients with coronary artery disease.

Observation:

• A patient underwent PCI of the left circumflex artery after TAVR valve-in-valve and a left main "chimney" stent.
• The procedure involved complex anatomy and potential complications related to prior interventions.
• Specific challenges encountered during cannulation and stenting were noted.

Findings:

• Successful PCI of the left circumflex artery was achieved despite anatomical challenges.
• The case demonstrates the feasibility of complex coronary interventions in the TAVR setting.
• Detailed procedural steps and decision-making are described.

Implications:

• This case provides insights into managing complex coronary access post-TAVR.
• It highlights the importance of specialized techniques for PCI in TAVR patients.
• Improved strategies for coronary access post-TAVR may enhance patient outcomes.