Real-Time Leaflet Monitoring Using Intravascular Ultrasound During Transcatheter Aortic Valve Implantation

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Device Technology

Background:

• Coronary obstruction (CO) is a rare but serious complication following transcatheter aortic valve implantation (TAVI).
• Prophylactic chimney stenting is a strategy to prevent CO in high-risk patients, but carries risks like impaired future coronary access and stent thrombosis.

Purpose of the Study:

• To report a case where intravascular ultrasound (IVUS) prevented unnecessary prophylactic chimney stenting during TAVI.
• To emphasize the utility of IVUS in real-time assessment of coronary access during TAVI procedures.

Main Methods:

• A case of self-expandable TAVI where IVUS was used for real-time monitoring.
• Observation of native leaflet displacement during valve expansion using IVUS.

Main Results:

• Intravascular ultrasound allowed for precise visualization of native aortic valve leaflet movement during self-expandable TAVI.
• This real-time monitoring enabled the successful avoidance of prophylactic chimney stenting.

Conclusions:

• Intravascular ultrasound is crucial for accurate assessment of coronary obstruction risk during self-expandable TAVI.
• Utilizing IVUS can prevent unnecessary chimney stenting, preserving future coronary access and reducing procedural complications.