A case of “chimney” stent technique for left coronary ostia obstruction during transcatheter aortic valve replacement_West China Medical Journal

Authors：

ZHANG Yiman , LI Yijian , SHI Ruijuan , LI Xi , XU Yuanning , XIONG Tianyuan , CHEN Fei ,  CHEN Mao ,  FENG Yuan

Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CHEN Mao, Email: hmaochen@vip.sina.com; FENG Yuan, Email: fynotebook@hotmail.com

Keywords：

Transcatheter aortic valve replacement; Coronary obstruction; “Chimney” stent

DOI：

10.7507/1002-0179.202003056

Video：

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This case was a 78-year-old woman characterized exertional dyspnea and diagnosed with severe aortic stenosis. Preoperative evaluation revealed that the patient had a very high surgical risk, so transcatheter aortic valve replacement (TAVR) was proposed. But this patient was at high risk of coronary obstruction. After weighing advantages and disadvantages, the heart team decided to choose TAVR under the protection of guide wire and balloon at last. Left coronary ostia obstruction happened after self-expanding valve released during TAVR. Then, emergency “chimney” stent implantation was performed. Finally, TAVR and coronary revascularization was successfully completed. The patient’s condition was improved after TAVR and being good in follow-up. Based on this case, risk factors of coronary obstruction during TAVR and effectiveness and safety of “chimney” stent technique was discussed.

Citation： ZHANG Yiman, LI Yijian, SHI Ruijuan, LI Xi, XU Yuanning, XIONG Tianyuan, CHEN Fei, CHEN Mao, FENG Yuan. A case of “chimney” stent technique for left coronary ostia obstruction during transcatheter aortic valve replacement. West China Medical Journal, 2020, 35(4): 479-483. doi: 10.7507/1002-0179.202003056 Copy

1.	Webb JG, Chandavimol M, Thompson CR, et al. Percutaneous aortic valve implantation retrograde from the femoral artery. Circulation, 2006, 113(6): 842-850.
2.	Ribeiro HB, Webb JG, Makkar RR, et al. Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry. J Am Coll Cardiol, 2013, 62(17): 1552-1562.
3.	Akinseye OA, Jha SK, Ibebuogu UN. Clinical outcomes of coronary occlusion following transcatheter aortic valve replacement: a systematic review. Cardiovasc Revasc Med, 2018, 19(2): 229-236.
4.	Buellesfeld L, Stefan S, Bindu K, et al. Aortic root dimensions among patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2013, 6(1): 72-83.
5.	Tops LF, Wood DA, Delgado V, et al. Noninvasive evaluation of the aortic root with multislice computed tomography implications for transcatheter aortic valve replacement. JACC Cardiovasc Imaging, 2008, 1(3): 321-330.
6.	Arai T, Lefèvre T, Hovasse T, et al. Incidence and predictors of coronary obstruction following transcatheter aortic valve implantation in the real world. Catheter Cardiovasc Interv, 2017, 90(7): 1192-1197.
7.	Holmes DR, Mack MJ, Kaul S, et al. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol, 2012, 59(13): 1200-1254.
8.	Ribeiro HB, Rodés-Cabau J, Blanke P, et al. Incidence, predictors, and clinical outcomes of coronary obstruction following transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: insights from the VIVID registry. Eur Heart J, 2018, 39(8): 687-695.
9.	Okuyama K, Hasan J, Makkar RR. Leaflet length and left main coronary artery occlusion following transcatheter aortic valve replacement. Catheter Cardiovasc Interv, 2013, 82(5): E754-E759.
10.	Spina R, Khalique O, George I, et al. Acute left main stem coronary occlusion following transcatheter aortic valve replacement in a patient without recognized coronary obstruction risk factors: a case report. Eur Heart J Case Rep, 2018, 2(4): yty112.
11.	Yamamoto M, Shimura T, Seiji K, et al. Impact of preparatory coronary protection in patients at high anatomical risk of acute coronary obstruction during transcatheter aortic valve implantation. Int J Cardiol, 2016, 217: 58-63.
12.	Palmerini T, Chakravarty T, Saia F, et al. Coronary protection to prevent coronary obstruction during TAVR: a multicenter international registry. JACC Cardiovasc Interv, 2020, 13(6): 739-747.
13.	Spaziano M, Akodad M, Hovasse T, et al. Simultaneous TAVR and left main “chimney”. stenting in a patient with low left main height. JACC Cardiovasc Interv, 2017, 10(20): e185-e187.
14.	Fiorina C, Curello S, Maffeo D, et al. Management of acute left main obstruction after transcatheter aortic valve replacement: the “tunnel technique”. Cardiovasc Revasc Med, 2012, 13(2): 142.e5-142.e9.

1. Webb JG, Chandavimol M, Thompson CR, et al. Percutaneous aortic valve implantation retrograde from the femoral artery. Circulation, 2006, 113(6): 842-850.
2. Ribeiro HB, Webb JG, Makkar RR, et al. Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry. J Am Coll Cardiol, 2013, 62(17): 1552-1562.
3. Akinseye OA, Jha SK, Ibebuogu UN. Clinical outcomes of coronary occlusion following transcatheter aortic valve replacement: a systematic review. Cardiovasc Revasc Med, 2018, 19(2): 229-236.
4. Buellesfeld L, Stefan S, Bindu K, et al. Aortic root dimensions among patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2013, 6(1): 72-83.
5. Tops LF, Wood DA, Delgado V, et al. Noninvasive evaluation of the aortic root with multislice computed tomography implications for transcatheter aortic valve replacement. JACC Cardiovasc Imaging, 2008, 1(3): 321-330.
6. Arai T, Lefèvre T, Hovasse T, et al. Incidence and predictors of coronary obstruction following transcatheter aortic valve implantation in the real world. Catheter Cardiovasc Interv, 2017, 90(7): 1192-1197.
7. Holmes DR, Mack MJ, Kaul S, et al. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol, 2012, 59(13): 1200-1254.
8. Ribeiro HB, Rodés-Cabau J, Blanke P, et al. Incidence, predictors, and clinical outcomes of coronary obstruction following transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: insights from the VIVID registry. Eur Heart J, 2018, 39(8): 687-695.
9. Okuyama K, Hasan J, Makkar RR. Leaflet length and left main coronary artery occlusion following transcatheter aortic valve replacement. Catheter Cardiovasc Interv, 2013, 82(5): E754-E759.
10. Spina R, Khalique O, George I, et al. Acute left main stem coronary occlusion following transcatheter aortic valve replacement in a patient without recognized coronary obstruction risk factors: a case report. Eur Heart J Case Rep, 2018, 2(4): yty112.
11. Yamamoto M, Shimura T, Seiji K, et al. Impact of preparatory coronary protection in patients at high anatomical risk of acute coronary obstruction during transcatheter aortic valve implantation. Int J Cardiol, 2016, 217: 58-63.
12. Palmerini T, Chakravarty T, Saia F, et al. Coronary protection to prevent coronary obstruction during TAVR: a multicenter international registry. JACC Cardiovasc Interv, 2020, 13(6): 739-747.
13. Spaziano M, Akodad M, Hovasse T, et al. Simultaneous TAVR and left main “chimney”. stenting in a patient with low left main height. JACC Cardiovasc Interv, 2017, 10(20): e185-e187.
14. Fiorina C, Curello S, Maffeo D, et al. Management of acute left main obstruction after transcatheter aortic valve replacement: the “tunnel technique”. Cardiovasc Revasc Med, 2012, 13(2): 142.e5-142.e9.

West China Medical Journal

A case of “chimney” stent technique for left coronary ostia obstruction during transcatheter aortic valve replacement

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