Key result
Emergent coronary catheterization for STEMI in a patient with a prior CoreValve implantation was profoundly restricted by the valve frame, resulting in a prolonged door-to-balloon time of 105 minutes.
Case Report (n=1)
No
Performing PCI in patients with prior TAVR using a CoreValve requires meticulous strategies and understanding of prosthetic valve geometry due to restricted catheter manipulation.
Requires meticulous PCI planning post-CoreValve; hypothesis-generating for valve-specific access strategies.
A 73-year-old man with severe aortic valve stenosis successfully underwent transcatheter aortic valve replacement (TAVR) using CoreValveTM (29 mm, Medtronic Inc., Minneapolis, MN, USA). Four years after the TAVR, he was hospitalized due to anterior ST-segment elevation myocardial infarction. Despite the need for prompt restoration of coronary flow in the infarct-related artery, the implanted CoreValveTM profoundly restricted the manipulation of diagnostic catheters during the coronary angiography. In particular, (I) guidewire easily migrated into the space between CoreValveTM and aorta vessel wall; (II) the nickel-titanium frame of CoreValveTM limited the space to manipulate catheters, making difficult to advance Judkins left (JL) 4, Judkins right (JR) 4 and Amplatz left 1 into coronary cusps; and (III) selecting specific spot within frame was required for cannulation. Left and right coronary arteries were barely engaged by JL3.5 and modified JR4, respectively. Percutaneous coronary intervention (PCI) for culprit lesion in the left-anterior descending artery was successfully completed by 6-French JL3.5 (BritetipTM, Cordis, Milpitas, CA, USA) with drug-eluting stent implantation. Meticulous strategies and understanding of the prosthetic valve geometry are warranted to conduct PCI in patients who underwent TAVR.
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Aikawa et al. (2018) conducted a case report in ST-segment elevation myocardial infarction after transcatheter aortic valve replacement (n=1). Percutaneous coronary intervention was evaluated on Door-to-balloon time and procedural success. Emergent coronary catheterization for STEMI in a patient with a prior CoreValve implantation was profoundly restricted by the valve frame, resulting in a prolonged door-to-balloon time of 105 minutes.
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