Multimodality Imaging for Facilitating Percutaneous Coronary Intervention of a Calcified Nodule Post Redo TAVR.

BACKGROUND

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.

CASE SUMMARY

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.

DISCUSSION

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.