How to address the coronaries in TAVI candidates: can the need for revascularization be safely determined by CT angiography only?

Figures

• 

  Figure 1. Prevalence of CAD in randomized studies and registries. Prevalence of CAD as reported in the major TAVI studies and registries of the last 14 years. CAD coronary artery disease; TAVI, transcatheter aortic valve implantation.

• 

  Figure 2. CTA (TAVI planning CT) and corresponding invasive CA and no coronary disease. A 84-year-old female patient, dyspnoea on exertion New York Heart Association (NYHA) III, no angina pectoris, and impaired kidney function. High-gradient AS on echocardiography with a peak velocity of 4.2 m/s. A shows the LAD, B shows the LCX, and C shows the RCA, all from the TAVI planning CT. D–F depict the corresponding images of stenosis-free coronaries by invasive CA. CT, computed tomography; LAD, left anterior descending artery; LCX, circumflex artery; RCA, right coronary artery; TAVI, transcatheter aortic valve implantation.

• 

  Figure 3. CTA (TAVI planning CT) and corresponding invasive CA and significant coronary disease. A 86-year-old male patient, dyspnoea on exertion NYHA III, no angina pectoris, and impaired kidney function. High-gradient AS, peak velocity on echocardiography 4.1 m/s. A shows left main stem and LAD with significant calcification and stenosis (blue arrow), B shows the LCX, which is also calcified, and C shows the RCA, all from the TAVI planning CT. D–F depict the corresponding images of the coronaries by invasive CA. The LAD was significantly stenosed. The patient underwent elective PCI of the LAD prior TAVI. CT, computed tomography; LAD, left anterior descending artery; LCX, circumflex artery; RCA, right coronary artery; TAVI, transcatheter aortic valve implantation.