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Review
. 2024 Dec 14;13(24):7625.
doi: 10.3390/jcm13247625.

Coronary Artery Disease and Severe Aortic Stenosis: Contemporary Treatment Options for Patients Undergoing Transcatheter Aortic Valve Implantation

Nikolaos Ktenopoulos  1 , Antonios Karanasos  2 , Odysseas Katsaros  1 , Anastasios Apostolos  1 , George Latsios  1 , Athanasios Moulias  2 , Michael I Papafaklis  2 , Grigorios Tsigkas  2 , Constantinos Tsioufis  1 , Konstantinos Toutouzas  1 , Periklis Davlouros  2
Affiliations
Review

Coronary Artery Disease and Severe Aortic Stenosis: Contemporary Treatment Options for Patients Undergoing Transcatheter Aortic Valve Implantation

Nikolaos Ktenopoulos et al. J Clin Med. .

Abstract

Approximately 50% of individuals eligible for transcatheter aortic valve implantation (TAVI) have coronary artery disease (CAD). The influence of CAD, both its prevalence and severity, on post-TAVI clinical results has yielded conflicting findings. Recent research has shown positive results for the use of computed tomography angiography and functional percutaneous evaluation of coronary lesions in the pre-TAVI assessment, besides the classic coronary angiography. As we anticipate the outcomes of current randomized studies, it has become common practice to perform invasive revascularization on TAVI patients with obstructive CAD. Furthermore, there is a lack of comprehensive data about the occurrence, features, and treatment of coronary incidents after TAVI. There is also growing concern about the possible difficulties in accessing the coronary arteries in patients who need coronary angiography with or without intervention after TAVI. This review presents a comprehensive analysis of the contemporary treatment options of CAD in patients undergoing TAVI. In this context, it examines the incidence of CAD in TAVI candidates; its clinical significance; the assessment and management of CAD before, concomitant, and after the procedure, including patients' unresolved concerns; and possible future aspects.

Keywords: TAVI; TAVR; aortic stenosis; cardiac catheterization; coronary artery disease; transcatheter aortic valve intervention.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Central illustration. This figure delineates the potential benefits and limitations of the three strategic approaches to revascularization in managing CAD among patients undergoing TAVI: pre-TAVI, concomitant with TAVI, and post-TAVI. Pre-TAVI revascularization allows for CAD stabilization prior to valve intervention, potentially mitigating peri-procedural complications, though it may delay TAVI. Concomitant revascularization synchronizes CAD and valve interventions, optimizing procedural efficiency but at the cost of increased complexity and risk of complications. Post-TAVI revascularization simplifies the initial procedure, prioritizing valve implantation but may defer CAD management, posing risks of delayed adverse events and challenges in coronary access. Abbreviations: CAD: coronary artery disease, AS: aortic stenosis, TAVI: transcatheter aortic valve implantation, THV: transcatheter heart valve, FFR: fractional flow reserve, iFR: instantaneous wave-free ratio, PCI: percutaneous coronary intervention.
Figure 2
Figure 2
Simultaneous percutaneous coronary intervention (PCI) of the left main and transcatheter aortic valve implantation (TAVI) in an 80-year-old female patient with severe aortic stenosis and obstructive left main coronary artery disease (arrow). (A) Baseline aortogram showing aortic valve stenosis and critical stenosis of the left main coronary artery necessitating revascularization. (B) Stent implantation at the left main ostium. (C) Aortogram after PCI. (D) Aortogram after Accurate Neo2 (Boston Scientific, Natick, MA, USA) transcatheter aortic valve implantation.
See this image and copyright information in PMC

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