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Updated: May 28, 2026

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
10:28

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

Published on: March 15, 2022

How to Individualize Coronary Assessment and Revascularization in Severe AS Patients Undergoing TAVI in the Era of

Krzysztof Sobczyk1, Miłosz Dziarmaga2, Mateusz Dziarmaga2

  • 1Department of Cardiology Intensive Therapy and Internal Medicine, University Clinical Hospital, Przybyszewskiego Street 49, 60-355 Poznan, Poland.

Journal of Clinical Medicine
|May 27, 2026
PubMed

Insights

Managing coronary artery disease (CAD) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) requires personalized strategies. Current evidence suggests a selective approach to percutaneous coronary intervention (PCI) before TAVI, moving away from routine procedures.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Coronary artery disease (CAD) frequently coexists with severe aortic stenosis (AS), complicating treatment decisions, especially with the increasing use of transcatheter aortic valve implantation (TAVI) in younger, lower-risk populations.
  • The management of CAD in AS patients undergoing TAVI presents unique diagnostic and therapeutic challenges, necessitating tailored, long-term clinical strategies.

Purpose of the Study:

  • To review current evidence on coronary assessment and revascularization strategies for patients with severe AS.
  • To discuss the evolving role of coronary imaging and percutaneous coronary intervention (PCI) in the context of TAVI.

Main Methods:

  • This narrative review synthesizes existing literature on coronary assessment and revascularization in severe AS patients.
  • Key methods include evaluating invasive coronary angiography and coronary computed tomography angiography (CCTA) for anatomical assessment.
  • The review examines data supporting selective versus routine PCI prior to TAVI.

Main Results:

  • Invasive coronary angiography is the primary method for coronary imaging, with CCTA emerging as a viable alternative for select patients.
  • Routine PCI before TAVI is increasingly questioned; a selective approach based on lesion characteristics and procedural factors is favored.
  • Uncertainties persist regarding lesion physiology, revascularization timing and completeness, and management of complex coronary disease.

Conclusions:

  • A selective, personalized approach to CAD management, including PCI, is recommended for patients with severe AS undergoing TAVI.
  • Further research, including phenotype-specific and longitudinal studies, is crucial to refine management algorithms for this complex patient group.
  • Optimizing coronary assessment and revascularization strategies is essential for improving long-term outcomes in TAVI candidates with CAD.

Keywords:
TAVIaortic stenosiscoronary artery diseasecoronary computed tomography angiographycoronary revascularization

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