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CT-Based Risk Stratification of Coronary Obstruction During TAVR: Clinical Utility and a New Volumetric Parameter

Ahmed Abdelhafez1, Niklas Lankisch1, Gianmarco Iannopollo2

  • 1Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany.

JACC. Cardiovascular Interventions
|June 9, 2026
PubMed

Insights

A CT-based algorithm effectively stratifies patients for coronary obstruction (CO) risk during transcatheter aortic valve replacement (TAVR). A novel parameter, valve-to-coronary volume (VTCV), accurately predicts CO, even when coronary protection measures are used.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Interventional Cardiology

Background:

  • Coronary obstruction (CO) during transcatheter aortic valve replacement (TAVR) is a rare but serious complication.
  • Computed tomography (CT)-based risk assessment algorithms are being developed to identify patients at high risk for CO.
  • The clinical utility of these CT algorithms requires further investigation.

Purpose of the Study:

  • To evaluate the clinical utility of a CT-derived algorithm in predicting CO during TAVR.
  • To identify predictors of CO, particularly in patients who undergo coronary protection (CP).

Main Methods:

  • A prospective study enrolled 164 patients at risk for CO during TAVR.
  • Preprocedural CT scans were used to classify patients into risk categories using a published algorithm.
  • A novel volumetric parameter, valve-to-coronary volume (VTCV), was calculated in high-risk patients.

Main Results:

  • The CT algorithm stratified patients into low (58.5%), intermediate (24.4%), and high (17.1%) risk categories.
  • All 7 CO events occurred in the high-risk group.
  • VTCV independently predicted CO with high accuracy (AUC 0.841) and outperformed VTC distance alone, validated in an external cohort.

Conclusions:

  • A CT-based algorithm effectively stratifies TAVR patients into CO risk categories.
  • While coronary protection (CP) reduces CO risk, its efficacy is limited in patients with very small VTCV.
  • VTCV, predictable via preprocedural CT, is a key predictor of CO and can guide CP decisions.
Abstract

Keywords:
computed tomographycoronary obstructioncoronary protectiontranscatheter aortic valve replacement

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