Key result
Chimney stenting prevents TAVR-related coronary obstruction effectively but impairs subsequent coronary access.
This review outlines CT-based anatomic predictors and preventive strategies—including chimney stenting, BASILICA, and ShortCut—to mitigate the high-mortality risk of coronary artery obstruction during TAVR and valve-in-valve procedures.
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CT predictors may flag high-risk TAVR valve-in-valve cases; leaves open prospective validation of chimney stenting.
Coronary artery obstruction is a rare complication of transcatheter aortic valve replacement (TAVR). This risk increases in TAVR-valve-in-valve procedure. Several anatomic risk factors were described in many studies to identify the predictive elements of coronary artery occlusion on computed tomography cardiac scan. Rescue percutaneous coronary intervention was the first approach described to treat this complication with a high mortality rate. Later on, preventive chimney stenting technique was evaluated and results showed that is a safe and effective strategy but it leads to a difficult coronary access later. New preventive techniques are being evaluated recently (Basilica and Shorctut).
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Dandach et al. (2026) conducted a review in Coronary artery obstruction in transcatheter aortic valve replacement (TAVR). Preventive techniques for coronary artery obstruction (chimney stenting, BASILICA, ShortCut) and rescue percutaneous coronary intervention was evaluated on Coronary artery obstruction and subsequent coronary access. Preventive chimney stenting during TAVR is safe and effective against coronary obstruction but complicates subsequent coronary access, prompting evaluation of BASILICA and ShortCut.
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