scholarly journals Asymptomatic Stroke in the Setting of Percutaneous Non-Coronary Intervention Procedures

Medicina ◽  
2021 ◽  
Vol 58 (1) ◽  
pp. 45
Author(s):  
Giovanni Ciccarelli ◽  
Francesca Renon ◽  
Renato Bianchi ◽  
Donato Tartaglione ◽  
Maurizio Cappelli Bigazzi ◽  
...  
Keyword(s):  
Rare Complication ◽  
Coronary Intervention ◽  
Pharmacological Therapy ◽  
Ischemic Brain ◽  
Coronary Syndrome ◽  
Left Atrial Appendage Occlusion ◽  
Transcatheter Aortic Valve ◽  
Standard Procedures ◽  
Valve Implantation ◽  
The Impact

Advancements in clinical management, pharmacological therapy and interventional procedures have strongly improved the survival rate for cardiovascular diseases (CVDs). Nevertheless, the patients affected by CVDs are more often elderly and present several comorbidities such as atrial fibrillation, valvular heart disease, heart failure, and chronic coronary syndrome. Standard treatments are frequently not available for “frail patients”, in particular due to high surgical risk or drug interaction. In the past decades, novel less-invasive procedures such as transcatheter aortic valve implantation (TAVI), MitraClip or left atrial appendage occlusion have been proposed to treat CVD patients who are not candidates for standard procedures. These procedures have been confirmed to be effective and safe compared to conventional surgery, and symptomatic thromboembolic stroke represents a rare complication. However, while the peri-procedural risk of symptomatic stroke is low, several studies highlight the presence of a high number of silent ischemic brain lesions occurring mainly in areas with a low clinical impact. The silent brain damage could cause neuropsychological deficits or worse, a preexisting dementia, suggesting the need to systematically evaluate the impact of these procedures on neurological function.

scholarly journals Percutaneous Coronary Intervention in Transcatheter Aortic Valve Implantation Patients: Overview and Practical Management

2021 ◽  
Vol 8 ◽  
Author(s):  
Maren Weferling ◽  
Christian W. Hamm ◽  
Won-Keun Kim
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Coronary Intervention ◽  
Transcatheter Aortic Valve ◽  
Practical Management ◽  
Percutaneous Coronary ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
The Impact

Coronary artery disease (CAD) is present in 40–75% of patients undergoing transcatheter aortic valve implantation (TAVI) for severe symptomatic aortic stenosis. Currently, the indication for TAVI is expanding toward younger patients at lower surgical risk. Given the progressive nature of CAD, the necessity for coronary angiography (CA), including percutaneous coronary intervention (PCI), will subsequently increase as in the future TAVI patients will be younger and have a longer life expectancy. Data on the impact of PCI in patients with severe CAD scheduled for TAVI are controversial, and although European and US guidelines recommend PCI before TAVI, the optimal timing for PCI remains unclear due to a lack of evidence. Depending on the valve type, position, and axial alignment of the implanted device, CA and/or PCI after TAVI can be challenging. Hence, every interventionalist should be familiar with the different types of transcatheter heart valves and their characteristics and technical issues that can arise during invasive coronary procedures. This review provides an overview of current data regarding the prevalence and clinical implications of CAD and PCI in TAVI patients and includes useful guidance for practical management in the clinical routine.

scholarly journals Case Report: Emergency High-Risk Percutaneous Coronary Intervention Following Transcatheter Aortic Valve Implantation in Bicuspid Anatomy

2021 ◽  
Vol 7 ◽  
Author(s):  
Ahmed El-Medany ◽  
Gemina Doolub ◽  
Amardeep Dastidar ◽  
Nikhil Joshi ◽  
Thomas Johnson ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Coronary Intervention ◽  
Emergency Setting ◽  
Coronary Syndrome ◽  
Transcatheter Aortic Valve ◽  
Percutaneous Coronary ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Background: Transcatheter aortic valve implantation (TAVR) continues to develop as a valuable alternative to surgical aortic valve replacement (SAVR) in an increasingly wide spectrum of patients with severe symptomatic aortic stenosis (AS). AS frequently coexists with coronary artery disease, and performing technically challenging percutaneous coronary intervention (PCI) following TAVR will become more frequent with increased use of TAVR.Case Summary: We herein report the case of a 53-years-old man with complex medical history including type 1 diabetes and dialysis-dependent renal failure and prior Evolut-R TAVR for critical bicuspid aortic valve stenosis who underwent intravascular ultrasound study (IVUS)-guided PCI to a critical distal left main stem (LMS) and proximal left anterior descending (LAD) lesion after presenting with ventricular fibrillation (VF) secondary to an acute coronary syndrome (ACS).Discussion: Selective engagement of coronary ostia through the side cells of TAVR prosthesis can be challenging, especially in an emergency setting. The particular challenges associated with this case are described, as well as an up-to-date literature search on strategies and equipment that can help in this situation.

P3630Coronary angiography and percutaneous coronary intervention post implantation of a transcatheter aortic valve

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Perrin ◽  
A Frei ◽  
A Fassa ◽  
J F Juan ◽  
F Rigamonti ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Heart Valves ◽  
Coronary Intervention ◽  
Coronary Angiogram ◽  
Coronary Syndrome ◽  
Transcatheter Aortic Valve ◽  
History Of ◽  
The Mean ◽  
Valve Implantation

Abstract When treating younger patients with longer life expectancy, the likelihood of having to perform a subsequent coronary angiogram and PCI during follow-up post transcatheter aortic valve implantation (TAVI) is increased. The aim of our study was to assess the feasibility and characteristics of the post TAVI coronary angiogram. We interrogated our prospective single center TAVI database to analyze data from patients who underwent a coronary angiogram or PCI post TAVI. Between August 2008 and January 2019, 405 consecutive TAVI were performed in our institution with a 30-day, 6-month and yearly follow-up. Among 405 procedures, 18 coronary angiograms with 9 PCI (RCA 2; LM 3; LAD 3, LCX 1) were performed in 17 patients post TAVI. The mean age of patients was 78.1±7.5 years (3 women), with a mean STS score of 5.6±3.4%. Five patients had a history of prior CABG. The transcatheter heart valves implanted were 6 CoreValve, 8 Evolut R, 1 Evolut Pro and 2 Edwards Sapien. The valve sizes were 31mm (n=3), 29mm (n=6), 26mm (n=3) and 23mm (n=5). The indication for the coronary angiogram was acute coronary syndrome for 8 procedures (1 STEMI, 7 NSTEMI) and stable angina for the remaining 10 procedures. The mean time between TAVI and coronary angiogram was 519±332 days (189–1093 days). Femoral and radial approach was used in, respectively, 11 and 7 (right: 5, left: 2) procedures with one cross-over needed from right transradial to transfemoral. Out of 33 attempted ostia cannulations, there were 2 failures (both involving the RCA), and 31 successes classified as selective (RCA: 7, LM: 9), borderline selective (RCA: 3, LM: 2) and non-selective but sufficient for diagnosis (RCA: 3, LM: 7), using standard catheters (average number of catheter used to cannulate RCA: 1.2±0.8 and LM: 1.7±1.1 [min. 1 and max. 4]). All planned PCI were successful with the treatment of 11 stenosis including 2 multivessel lesions. In 44% of the treated arteries, the use of a GuideLiner catheter (Vascular Solutions Inc) was required to cannulate the ostium. In conclusion, coronary angiogram post TAVI was needed in 4.2% of our cohort during follow-up. Overall, LM ostia cannulation was successful in 100% of the cases and we failed to cannulate 13.3% of RCA ostia. All PCI were successful with the need of a guiding cathteter extension in 44% of the procedures.

Rescue Transcatheter Aortic Valve Implantation and Simultaneous Percutaneous Coronary Intervention on Cardiopulmonary Bypass in a Patient with an Extreme Risk Profile

2012 ◽  
Vol 15 (3) ◽  
pp. 164 ◽  
Author(s):  
Miralem Pasic ◽  
Stephan Dreysse ◽  
Evgenij Potapov ◽  
Axel Unbehaun ◽  
Semih Buz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Coronary Revascularization ◽  
Multiorgan Failure ◽  
Coronary Intervention ◽  
Risk Scores ◽  
Transcatheter Aortic Valve ◽  
Percutaneous Coronary ◽  
Aortic Valve Implantation ◽  
Valve Implantation

We report on successful emergency transcatheter aortic valve implantation combined with percutaneous coronary revascularization in a polymorbid and preterminal patient in profound cardiogenic shock and with multiorgan failure. The risk scores were almost unbelievably high (Society of Thoracic Surgeons mortality score, 83.9%; Society of Thoracic Surgeons morbidity and mortality score, 96.8%; logistic EuroSCORE, 96.7%). Two and a half years after the procedure, the patient is doing very well.

A valve-in-valve transcatheter aortic valve implantation with commissural alignment using advanced imaging reconstruction: a case report

2020 ◽  
Vol 3 (10) ◽  
pp. 01-05
Author(s):  
Marco Angelillis
Keyword(s):  
Aortic Valve ◽  
Severe Aortic Stenosis ◽  
Coronary Intervention ◽  
Easy Access ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Structural Valve Deterioration ◽  
Valve In Valve ◽  
Transcatheter Valve ◽  
Valve Implantation

Transcatheter valve in valve (ViV) implantation actually represents a valid alternative to surgical reinterventions in patients with previous surgical aortic valve replacement (AVR). In patients less than 80 years old, it is crucial to correctly position the new valve leaving a feasible and easy access to coronary ostia, both for future percutaneous coronary intervention (PCI) than for a future possible TAVinTAV procedure. We report a 71 year old man with prior AVR presented with structural valve deterioration (SVD) leading to severe aortic stenosis. In order to guarantee comfortable coronary access we aligned, the commissures of the new percutaneous valve with the ones of the surgical bioprothesis by reconstructing the headframes of the surgical bioprosthesis with computer tomography (CT) and fluoro-CT.

A rare complication with Edwards Sapien: Aortic valve embolization in TAVI

Vascular ◽  
2014 ◽  
Vol 23 (1) ◽  
pp. 102-104 ◽  
Author(s):  
Hüseyin Ayhan ◽  
Tahir Durmaz ◽  
Telat Keleş ◽  
Hacı Ahmet Kasapkara ◽  
Kemal Eşref Erdoğan ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Carotid Artery ◽  
Transcatheter Aortic Valve Implantation ◽  
Common Carotid Artery ◽  
Rare Complication ◽  
Transcatheter Aortic Valve ◽  
Truncus Brachiocephalicus ◽  
Edwards Sapien ◽  
Aortic Valve Implantation ◽  
Valve Implantation

One of the problems is valve embolization at the time of transcatheter aortic valve implantation, which is a rare but serious complication. In this case, we have shown balloon expandable aortic valve embolization TAVI which is a rare complication and we managed with second valve without surgery. Although there is not enough experience in the literature, embolized valve was re-positioned in the arch aorta between truncus brachiocephalicus and left common carotid artery.

Sign in / Sign up

Export Citation Format

Share Document