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Delayed Chimney Stent Fracture After Transcatheter Aortic Valve Replacement
Cunjun Zhu1, Rongzhen Zhang1, Yuanjiu Yang1
1Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
Background:
Chimney stenting represents an established coronary protection strategy during transcatheter aortic valve replacement (TAVR) in high-risk anatomical settings, although chimney stent fracture remains a rare complication.
Case Summary:
A 55-year-old woman with severe aortic stenosis underwent TAVR with a self-expanding valve and left main chimney stenting due to a low-lying left coronary artery (10.2 mm). One month postprocedure, she presented with recurrent chest pain and elevated troponin. Coronary angiography revealed delayed chimney stent fracture with compromised left main flow, requiring urgent balloon dilatation and restenting. At 1-year follow-up, left ventricular function was preserved.
Conclusion:
This case highlights delayed stent fracture as a rare but serious complication of chimney stenting following TAVR. Imaging surveillance is warranted in patients with postprocedural chest pain to avoid diagnostic oversight.
Take-Home Messages:
Delayed stent fracture following chimney stenting for coronary protection during TAVR may present weeks after an initially successful procedure with acute coronary syndrome-like symptoms, requiring urgent coronary angiography and reintervention. Continuous radial force from self-expanding transcatheter valve frames may contribute to chronic mechanical stress on chimney stents. Preoperative assessment of coronary ostial angulation should be considered in patients with high-risk coronary anatomy undergoing TAVR.
