Rotational atherectomy through a coronary artery bypass graft after transcatheter aortic valve implantation: a case report - INRAE - Institut national de recherche pour l’agriculture, l’alimentation et l’environnement Access content directly
Journal Articles European Heart Journal. Case Reports Year : 2020

Rotational atherectomy through a coronary artery bypass graft after transcatheter aortic valve implantation: a case report

Abstract

Background Aortic stenosis (AS) in the elderly is frequently associated with complex coronary artery disease. Rotational atherectomy (RA) in this clinical setting is challenging because coronary slow flow could lead to haemodynamic instability aggravated by the severe AS. Case summary We present the case of an 83-year-old woman with symptomatic severe AS, mildly decreased left ventricular ejection fraction and history of coronary artery bypass grafting with right internal mammary artery (RIMA) to the right coronary artery (RCA) and left internal mammary artery to the left anterior descending artery and further percutaneous coronary intervention (PCI) to the circumflex. First, we performed a transcatheter aortic valve implantation (TAVI) to treat the severe AS. Because of persistent symptoms despite good result, we then performed RA of the native RCA through the RIMA with a Guidezilla® guide extension catheter. Discussion A two-staged procedure of TAVI and PCI with RA of the RCA via RIMA was successfully performed. We decided to perform the PCI after the TAVI to allow a better haemodynamic tolerance of the complex coronary intervention. This procedure needs caution as the conduit is fragile and could be easily damaged during the RA. No data are available about feasibility and safety of RA through a native graft, but this could be a first step to consider it.
Fichier principal
Vignette du fichier
ytaa298.pdf (306.77 Ko) Télécharger le fichier
Origin Publisher files allowed on an open archive
Licence

Dates and versions

hal-03314529 , version 1 (04-07-2023)

Licence

Identifiers

Cite

Edgar Illescas, Thomas Cuisset, Jean-Charles Spychaj, Pierre Deharo. Rotational atherectomy through a coronary artery bypass graft after transcatheter aortic valve implantation: a case report. European Heart Journal. Case Reports, 2020, 4 (5), pp.1-5. ⟨10.1093/ehjcr/ytaa298⟩. ⟨hal-03314529⟩
21 View
7 Download

Altmetric

Share

Gmail Mastodon Facebook X LinkedIn More