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

Coronary obstruction (CO) is a rare but fatal complication after transcatheter aortic valve implantation. "Prophylactic" chimney stenting is effective in patients with high CO risk; however, concerns about future coronary access and stent thrombosis have emerged. We experienced a case in which intravascular ultrasound enabled real-time monitoring of displaced native leaflets during a self-expandable transcatheter heart valve expansion, consequently avoiding chimney stenting. This case highlights the importance of intravascular ultrasound to accurately assess CO during self-expandable transcatheter aortic valve implantation and prevent unnecessary chimney stenting.