Feasibility of guiding catheter exchange using extension wire in percutaneous coronary intervention after...

Area of Science:

• Interventional Cardiology
• Cardiovascular Devices
• Structural Heart Disease

Background:

• Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
• Percutaneous coronary intervention (PCI) following TAVR presents unique challenges due to the presence of the transcatheter heart valve (THV).
• Engaging coronary arteries after TAVR often requires specialized techniques to navigate the THV.

Purpose of the Study:

• To evaluate the feasibility and success of using an extension wire (EW) for diagnostic catheter (DC) to guiding catheter (GC) exchange during PCI after TAVR.
• To assess the procedural outcomes and effectiveness of this technique in complex coronary interventions.

Main Methods:

• A retrospective analysis of 11 PCI cases performed after TAVR between January 2020 and June 2024.
• Utilized an extension wire (EW) to facilitate the transition from a diagnostic catheter (DC) to a guiding catheter (GC).
• Reviewed clinical, angiographic, and procedural data, defining success as successful DC-to-GC exchange and completion of PCI.

Main Results:

• The EW-assisted DC-to-GC exchange was successful in all 11 cases (100%).
• Successful revascularization was achieved in 10 out of 11 patients (91%).
• Lesions were complex (ACC/AHA Type B2/C), and various THV types (SAPIEN, Evolut, Navitor) and guiding catheters were used.

Conclusions:

• The use of an extension wire (EW) is a feasible and highly successful method for facilitating diagnostic catheter (DC) to guiding catheter (GC) exchange during PCI after TAVR.
• This technique simplifies complex PCI procedures in patients with a transcatheter heart valve (THV).
• Employing an EW optimizes procedural outcomes and offers a valuable approach for interventional cardiologists managing post-TAVR PCI.