Al Nooryani Arif, Taha Rania, Sianos George, Khashaba Ahmed, Baradie Basem, Abdelrahman Nagwa
Cardiovascular Department, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates.
Emirates Health Services, Al Qassimi Hospital, Sharjah, United Arab Emirates.
JACC Case Rep. 2025 Jun 25;30(16):104013. doi: 10.1016/j.jaccas.2025.104013.
Transcatheter aortic valve replacement (TAVR) is vital for treating aortic stenosis, but coronary access after redo TAVR remains challenging. As TAVR is extended to younger patients, managing concurrent coronary artery disease will become crucial, with multidetector computed tomography (MDCT) playing a key role in coronary intervention planning.
An 83-year-old woman with multiple comorbidities and a history of redo TAVR and recent left main coronary artery stenting presented with NSTEMI. Imaging showed significant coronary involvement, prompting MDCT and intravascular ultrasound (IVUS) evaluation. Percutaneous coronary intervention (PCI) was performed, successfully treating severe calcified ostial stenosis.
This case demonstrates the value of MDCT and IVUS in managing complex coronary lesions after redo TAVR. It highlights the importance of preprocedural imaging to overcome coronary access challenges in patients with previous TAVR.
TAKE-HOME MESSAGES: MDCT and IVUS are vital for planning PCI in post redo-TAVR patients. Coronary access is achievable with proper imaging guidance.
经导管主动脉瓣置换术（TAVR）对于治疗主动脉瓣狭窄至关重要，但再次TAVR后的冠状动脉通路仍然具有挑战性。随着TAVR扩展至年轻患者，处理并存的冠状动脉疾病将变得至关重要，多层螺旋计算机断层扫描（MDCT）在冠状动脉介入治疗规划中发挥关键作用。
一名83岁女性，有多种合并症，有再次TAVR病史且近期行左主干冠状动脉支架置入术，出现非ST段抬高型心肌梗死（NSTEMI）。影像学检查显示冠状动脉有明显病变，促使进行MDCT和血管内超声（IVUS）评估。进行了经皮冠状动脉介入治疗（PCI），成功治疗了严重的钙化开口处狭窄。
该病例展示了MDCT和IVUS在处理再次TAVR后复杂冠状动脉病变中的价值。它凸显了术前成像对于克服既往有TAVR患者冠状动脉通路挑战的重要性。
MDCT和IVUS对于再次TAVR术后患者的PCI规划至关重要。在适当的成像引导下可实现冠状动脉通路。
