Intravascular Ultrasound for the Prevention of Coronary Artery Occlusion During Transcatheter Aortic Valve Replacement

Predicting coronary artery occlusion after transcatheter aortic valve replacement (TAVR) is usually based on computed tomography angiography (CTA). The primary risk factors seem to be a low coronary artery take-off and a small aortic root. However, CTA sometimes provides ambiguous risk assessment, and even if a potentially risky coronary artery is secured with a guidewire, the need for coronary stenting after valve implantation often remains uncertain. To reduce uncertainty, intravascular ultrasound (IVUS) can be used. The following two cases highlight the utility of IVUS in addressing these issues.