Intentional left main stentectomy with a drug-coated balloon-only strategy enabled safe TAVR with preserved coronary access and a patent stentectomy site at 7 months.
Case Report (n=1)
Intentional left main stentectomy with a drug-coated balloon-only strategy can enable safe TAVR with preserved coronary access in patients with protruding aorto-ostial stents.
Protruding aorto-ostial coronary stents may compromise coronary access during and after transcatheter aortic valve replacement (TAVR). A 75-year-old woman with severe aortic stenosis, advanced chronic kidney disease, and a non-ST-elevation myocardial infarction was found to have a chronically implanted drug-eluting stent protruding from the ostial left main coronary artery into the aorta, precluding selective coronary engagement. After treating the calcified left circumflex artery with intravascular lithotripsy and stent implantation, the protruding stent was retrieved intact using a tri-loop snare through a guide extension catheter. Intravascular ultrasound confirmed complete removal with preserved luminal area. Drug-coated balloon angioplasty was performed to preserve a metal-free ostium. TAVR was performed successfully with preserved selective coronary engagement. At seven months, the stentectomy site remained patent; the patient died of cardiogenic shock from unrelated bilateral ostial in-stent restenosis. This case demonstrates that intentional left main stentectomy with a drug-coated balloon-only strategy can enable safe TAVR with preserved coronary access.
Filho et al. (Mon,) conducted a case report in Severe aortic stenosis with protruding aorto-ostial coronary stent (n=1). Intentional left main stentectomy and drug-coated balloon angioplasty was evaluated on Procedural success and stentectomy site patency. Intentional left main stentectomy with a drug-coated balloon-only strategy enabled safe TAVR with preserved coronary access and a patent stentectomy site at 7 months.