Plaque modification techniques in patients with CHD undergoing TAVI: the experience of our center

To the Editor, Aortic stenosis (AS) is the most prevalent valvular heart disease in Western countries.1 The coexistence of AS and coronary artery disease (CAD) is a common finding, and due to the aging population,2 an increase in prevalence is expected in the coming years. The 2 diseases share cardiovascular risk factors and likely a common pathophysiological pathway: in the early stages of aortic valve degeneration, lipid and macrophage deposits, along with an inflammatory response have been observed, resembling the process observed in atherosclerosis.2 The prevalence of CAD in patients with severe AS has been documented to range between 25% and 50%. A total of 39% of patients treated with surgical valve replacement require coronary revascularization,2 and 50% of those undergoing transcatheter aortic valve implantation (TAVI) have CAD.3 Although the indication for percutaneous coronary intervention (PCI) prior to TAVI varies across center, factors such as angina functional class and angiographic characteristics (lesion severity, access, and anticipated technical difficulty) play a critical role in decision-making. Additionally, PCI requires dual antiplatelet therapy, which can increase bleeding risk.4 These patients usually have calcified lesions,5 adding complexity to the PCI. In recent years, significant advancements have been made in plaque modification devices, enabling individualized approaches...