TY - JOUR

T1 - Transcatheter treatment of severe aortic stenosis in patients with complex coronary artery disease

T2 - case series and proposed therapeutic algorithm

AU - Soriano, Francesco

AU - Montalto, Claudio

AU - Calderone, Dario

AU - Nava, Stefano

AU - Esposito, Giuseppe

AU - Saia, Francesco

AU - Oreglia, Jacopo A.

AU - Søndergaard, Lars

N1 - Publisher Copyright: © The Author(s) 2022.

PY - 2022

Y1 - 2022

N2 - BackgroundPatients with severe aortic stenosis (AS) and complex coronary artery disease with a clinical indication to both transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) pose a clinical dilemma since it is unclear which lesion should be treated first and careful planning is required.Case summary We report two cases of AS with complex PCI (ASCoP) features. In the first one, easy coronary cannulation with an Acurate Neo2 valve and commissural alignment was predicted; therefore, TAVI was performed first, and subsequently complex high-risk PCI of the left main was performed in the same procedure but without the burden of ongoing severe AS. In the second case, complex coronary cannulation after TAVI with an Evolut PRO valve was predicted; therefore, balloon aortic valvuloplasty and Impella placement were performed first to allow for complex, high-risk multivessel PCI and subsequent TAVI. In both cases, a single-stage approach was preferred to reduce the use of large-bore arterial access with possible consequent adverse events.DiscussionIn this case series, we illustrate a possible approach to the treatment of ASCoP patients. In such complex cases, a thorough preprocedural planning is mandatory, and clinical decision-making should be centred upon the predicted chance of cannulation of coronary arteries after TAVI.

AB - BackgroundPatients with severe aortic stenosis (AS) and complex coronary artery disease with a clinical indication to both transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) pose a clinical dilemma since it is unclear which lesion should be treated first and careful planning is required.Case summary We report two cases of AS with complex PCI (ASCoP) features. In the first one, easy coronary cannulation with an Acurate Neo2 valve and commissural alignment was predicted; therefore, TAVI was performed first, and subsequently complex high-risk PCI of the left main was performed in the same procedure but without the burden of ongoing severe AS. In the second case, complex coronary cannulation after TAVI with an Evolut PRO valve was predicted; therefore, balloon aortic valvuloplasty and Impella placement were performed first to allow for complex, high-risk multivessel PCI and subsequent TAVI. In both cases, a single-stage approach was preferred to reduce the use of large-bore arterial access with possible consequent adverse events.DiscussionIn this case series, we illustrate a possible approach to the treatment of ASCoP patients. In such complex cases, a thorough preprocedural planning is mandatory, and clinical decision-making should be centred upon the predicted chance of cannulation of coronary arteries after TAVI.

KW - Case reports

KW - CHIP

KW - Commissural alignment

KW - Complex PCI

KW - TAVI

U2 - 10.1093/ehjcr/ytac399

DO - 10.1093/ehjcr/ytac399

M3 - Journal article

C2 - 36225807

AN - SCOPUS:85142826369

VL - 6

JO - European Heart Journal - Case Reports

JF - European Heart Journal - Case Reports

SN - 2514-2119

IS - 10

M1 - ytac399

ER -