Proactive coronary protection using IVUS-guided decision making and chimney stenting during high-risk TAVR resulted in favorable clinical outcomes without periprocedural complications in two patients.
Case Report (n=2)
Does an IVUS-guided proactive coronary protection strategy with chimney stenting prevent coronary obstruction in patients with severe aortic stenosis and high-risk anatomy undergoing TAVR?
IVUS-guided decision making and chimney stenting can be a safe and effective proactive strategy for coronary protection in high-risk TAVR patients.
BACKGROUND: We report a proactive coronary protection strategy during transcatheter aortic valve replacement (TAVR) using intravascular ultrasound (IVUS)-guided decision making and chimney stenting in patients with high-risk anatomy. CASE SUMMARY: Two patients with severe symptomatic aortic stenosis and unfavorable coronary anatomy on preprocedural computed tomography underwent TAVR with planned coronary protection. Despite preserved angiographic flow after valve deployment, IVUS identified critical leaflet-to-coronary proximity in one case, whereas significant ostial compromise was detected by angiography in the other. Chimney stenting was performed, ensuring maintained coronary patency. Both patients had favorable clinical outcomes without periprocedural complications and good follow-up results. DISCUSSION: These cases highlight some limitations of angiography and the complementary value of IVUS in selected situations and support a proactive decision-making process for an imaging-guided approach to coronary protection during TAVR. TAKE-HOME MESSAGE: A proactive, imaging-guided decision-making approach to coronary protection is recommended in cases of high-risk TAVR.
Nguyen et al. (Mon,) conducted a case report in Severe symptomatic aortic stenosis and unfavorable coronary anatomy (n=2). Intravascular ultrasound (IVUS)-guided decision making and chimney stenting was evaluated on Clinical outcomes and periprocedural complications. Proactive coronary protection using IVUS-guided decision making and chimney stenting during high-risk TAVR resulted in favorable clinical outcomes without periprocedural complications in two patients.