Precision Management of High-Risk Coronary Obstruction During TAVR Using a Physiology-Guided Strategy

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe aortic stenosis and high-risk coronary artery obstruction anatomy (n=1). Intervention: Physiology-guided strategy using dynamic fractional flow reserve (FFR). Primary outcome: Ischemic threshold (FFR >0.80).

Q: What does this research mean for the field?

A physiology-guided strategy enables precision management of high-risk coronary obstruction during transcatheter aortic valve replacement (TAVR), potentially avoiding the long-term risks associated with prophylactic chimney stenting. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yiwei Xu; Xiang Chen; Bin Wang; Yan Wang

doi:10.1016/j.jaccas.2026.108251

April 1, 2026JACC Case ReportsOpen Access

Precision Management of High-Risk Coronary Obstruction During TAVR Using a Physiology-Guided Strategy

View Full Paper

Ask AI

Bookmark

Share

Key result

Physiology-guided strategy for high-risk coronary obstruction during TAVR potentially avoids prophylactic chimney stenting.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Coronary artery obstruction is a rare but devastating complication of TAVR, and prophylactic chimney stenting carries long-term risks.

Does physiological assessment using FFR prevent unnecessary chimney stenting in a patient with high-risk coronary obstruction anatomy during TAVR?

Key Points

Determine whether dynamic fractional flow reserve monitoring can evaluate functional ischemia and safely prevent unnecessary prophylactic chimney stenting during high-risk transcatheter aortic valve replacement.
Assessed a 72-year-old female patient undergoing transcatheter aortic valve replacement who presented with severe aortic stenosis and high-risk anatomy for coronary obstruction, including a low left coronary ostium height of 9.1 mm.
Conducted real-time, dynamic fractional flow reserve assessments following valve deployment and aggressive balloon postdilations despite angiographic signs of delayed contrast clearance.
Dynamic fractional flow reserve values consistently remained above the ischemic threshold (>0.80) after valve deployment and balloon postdilations, ruling out significant physiological ischemia.
Prophylactic chimney stenting was successfully avoided, and the patient remained free of symptoms at the 3-month clinical follow-up.

Study Design

Type

Case Report (n=1)

Structured PICO

Does physiological assessment using FFR prevent unnecessary chimney stenting in a patient with high-risk coronary obstruction anatomy during TAVR?

P

Population

A 72-year-old woman with severe aortic stenosis and high-risk coronary artery obstruction anatomy undergoing TAVR, followed for 3 months.

I

Intervention

Physiological assessment using dynamic fractional flow reserve (FFR) monitoring during transcatheter aortic valve replacement (TAVR)

O

Outcome

Functional significance of anatomical proximity (FFR >0.80) and clinical status at 3-month follow-upsurrogate

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Dynamic FFR monitoring during TAVR can differentiate anatomical proximity from true functional ischemia, safely avoiding unnecessary chimney stenting in high-risk anatomy.

Abstract

BACKGROUND: Coronary artery obstruction is a rare but devastating complication of transcatheter aortic valve replacement (TAVR). Prophylactic chimney stenting is a bailout strategy but carries long-term risks. CASE SUMMARY: A 72-year-old woman with severe aortic stenosis and high-risk coronary artery obstruction anatomy (low left coronary ostium height of 9.1 mm, redundant calcified leaflet) underwent TAVR. Angiography after valve deployment showed ambiguous left coronary leaflet displacement with delayed contrast clearance. However, immediate and dynamic fractional flow reserve (FFR) assessments consistently remained above the ischemic threshold (>0.80) despite aggressive balloon postdilations. Consequently, chimney stenting was safely deferred. The patient was asymptomatic at the 3-month follow-up. DISCUSSION: Relying solely on anatomical predictors may lead to overtreatment. Physiological assessment using FFR effectively defines the functional significance of anatomical proximity, safely avoiding unnecessary permanent implants. TAKE-HOME MESSAGE: Dynamic FFR monitoring differentiates anatomical proximity from true functional ischemia during TAVR, safely guiding the avoidance of unnecessary chimney stenting.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Xu et al. (2026) conducted a case report in Severe aortic stenosis and high-risk coronary artery obstruction anatomy (n=1). Physiology-guided strategy using dynamic fractional flow reserve (FFR) was evaluated on Ischemic threshold (FFR >0.80). Dynamic FFR monitoring during TAVR demonstrated FFR >0.80 despite high-risk anatomy, safely guiding the avoidance of unnecessary chimney stenting.

synapsesocial.com/papers/69e5c27e03c2939914028ad9 https://doi.org/10.1016/j.jaccas.2026.108251

View Full Paper

Ask AI

Bookmark

Share

Precision Management of High-Risk Coronary Obstruction During TAVR Using a Physiology-Guided Strategy

Figures

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Precision Management of High-Risk Coronary Obstruction During TAVR Using a Physiology-Guided Strategy

Figures

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading