Key result
IVUS-guided stent-in-stent PCI successfully restores coronary flow after very late post-TAVI stent compression.
Why the study?
Coronary obstruction is a rare, high-mortality complication of TAVI, and the sequential occurrence of both acute and delayed presentations in the same patient is exceedingly rare.
Case Report (n=1)
No
Answers are grounded in this paper and cite their sources.
This case expands the known mechanical spectrum of very late coronary obstruction after TAVI to include extrinsic stent compression by an aortic wall hematoma and highlights the critical role of intravascular ultrasound in diagnosis and stent-in-stent management.
Coronary obstruction is a rare but catastrophic complication of transcatheter aortic valve implantation (TAVI) associated with high mortality. While acute and delayed presentations have distinct pathophysiological mechanisms, their occurrence in the same patient is exceedingly rare. We present a unique case of a 91-year-old female who developed acute left main coronary artery (LMCA) obstruction immediately following native TAVI using a balloon-expandable valve, which was successfully treated with bail-out percutaneous coronary intervention (PCI). Three months later (> 60 days, classified as "Very Late" coronary obstruction), she presented with severe angina and heart failure. Intravascular ultrasound (IVUS) revealed extrinsic compression of the previously implanted coronary stent caused by a localized aortic wall hematoma. A repeat PCI with a stent-in-stent technique restored coronary flow, leading to complete clinical recovery. This case expands the known mechanical spectrum of very late coronary obstruction according to recent classification frameworks and highlights the vital role of intravascular imaging and multimodality assessment in diagnosis and management.
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Akyüz et al. (2026) conducted a case report in Sequential acute and very late left main coronary artery obstruction following native transcatheter aortic valve implantation (TAVI) (n=1). Bail-out percutaneous coronary intervention (PCI) followed by IVUS-guided repeat PCI with a stent-in-stent technique was evaluated on Restoration of coronary flow and clinical recovery. IVUS-guided repeat PCI with a stent-in-stent technique restored coronary flow in a 91-year-old female with very late (>60 days) post-TAVI stent compression by an aortic wall hematoma.
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