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Published on: May 21, 2017
"Roundabout" Bailout Stenting for Subacute Right Coronary Artery Obstruction After Self-Expandable Transcatheter
Tatsuki Furusawa1, Hiroyuki Kiriyama1, Yuji Manabe1
1Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Background:
Coronary artery obstruction after transcatheter aortic valve replacement (TAVR) is a rare but life-threatening condition. A bailout strategy has not yet been standardized.
Case Summary:
A 91-year-old woman underwent TAVR with a self-expanding valve. Shortly after an initially uneventful procedure, she developed cardiac arrest due to subacute occlusion of the right coronary artery. Although the right coronary sinus was sequestered by the transcatheter heart valve, selective right coronary artery access was achieved via a "roundabout" approach from the noncoronary cusp. Two overlapping zotarolimus-eluting stents across the native commissure restored coronary flow, with satisfactory midterm patency.
Discussion:
The mechanisms of coronary artery obstruction and the spatial relationship between the native valve and transcatheter heart valve vary according to patient anatomy and device configuration, necessitating tailored bailout strategies after TAVR.
Take-Home Message:
A "roundabout" approach via the adjacent cusp may allow coronary access and revascularization when the coronary sinus is sequestered.
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