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High risk of coronary artery obstruction during TAVR, how to avoid it?
Jose R Gayosso-Ortíz1,2, Juan F Garcia-Garcia1,2, Jose Alfredo Merino-Rajme1
1Interventional cardiology service, National Medical Center, November 20, Mexico City, Mexico.
Insights
Coronary obstruction during transcatheter aortic valve replacement (TAVR) is a serious risk. A chimney stent technique successfully treated left main coronary artery obstruction in one patient, highlighting its preventive potential.
Area of Science:
- Cardiology
- Interventional Cardiology
- Structural Heart Disease
Background:
- Coronary artery obstruction is a critical complication following transcatheter aortic valve replacement (TAVR), often leading to high mortality.
- Predictors include ostial distance, calcification, and sinus proximity, necessitating preventative and therapeutic strategies.
Background:
Coronary artery obstruction after percutaneous aortic replacement is a complication with high short-term mortality secondary to the lack of timely treatment. There are various predictors of coronary obstruction prior to valve placement such as the distance from the ostia, the degree of calcification, the distance from the sinuses; In such a situation some measures must be taken to prevent and treat coronary obstruction.
Case Presentation:
An 84-year-old male, with severe aortic stenosis and high surgical risk, who was treated with TAVR. However, during the deployment of the valve he presented hemodynamic instability secondary to LMCA obstruction. The intravascular image showed obstruction of the ostium secondary to the displacement of calcium that he was successfully treated with a chimney stent technique.
Conclusions:
The high degree of calcification and the left ostium near the annulus are conditions for obstruction of the ostium at the time of valve release; In this context, provisional stenting prior to TAVR in patients at high risk of obstruction should be considered as a safe prevention strategy to achieve the success of the procedure.
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