Key result
Pre-emptive chimney stenting with a 24-mm VitaFlow valve prevented coronary obstruction in a 78-year-old woman with a small left coronary sinus, maintaining left main patency at 3 months.
Why the study?
Coronary obstruction is an infrequent but life-threatening complication during TAVR, particularly in patients with high-risk anatomy such as a small congenital left coronary sinus.
Case Report (n=1)
No
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Case report demonstrates chimney stenting preventing coronary obstruction during transcatheter aortic valve replacement, indicating a viable strategy for small coronary sinuses.
BACKGROUND: Coronary obstruction (CO) is an infrequent but life-threatening complication during transcatheter aortic valve replacement (TAVR). CASE SUMMARY: We report the case of a patient who accepted TAVR with high anatomical risks of CO due to the small congenital left coronary sinus, which was treated with preliminary coronary protection. This case highlighted the importance of computed tomography angiography (CTA) evaluation, 3D-printing stimulation, predilation as a reference sign, and pre-emptive chimney stenting technology to successfully anticipate and prevent CO during TAVR. At the 3rd month follow-up, CTA evaluation and 3D-printing simulation identified the chimney stenting of the left main coronary arterial patency. DISCUSSION: A 'four-step assessment' method also proposes a new clinical procedure on how to perform TAVR in patients with high risks of CO.
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Chen et al. (2022) conducted a case report in Symptomatic severe aortic valve stenosis with a congenital small left coronary sinus and high risk of coronary obstruction (n=1). Transcatheter aortic valve replacement (24-mm VitaFlow valve) with pre-emptive chimney stenting (4.5 mm x 21 mm GuReater stent) guided by a four-step assessment (CTA, 3D-printing simulation, and balloon predilation) was evaluated on Left main coronary arterial chimney stent patency and prevention of coronary obstruction at 3-month follow-up. Pre-emptive chimney stenting with a 24-mm VitaFlow valve prevented coronary obstruction in a 78-year-old woman with a small left coronary sinus, maintaining left main patency at 3 months.
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