Coronary protection in TAVI: use of the guide catheter extension system

It was decided to perform transcatheter aortic valve implantation (TAVI) in an 82-year-old woman with severe aortic stenosis who had mitral and tricuspid mechanical prostheses, and no coronary lesions. Computed tomography showed an annulus – left coronary artery (LCA) distance of 10.5 mm. There were indicators of coronary occlusion risk: a 21.2 mm sinotubular junction, a left leaflet length (figure 1A, asterisk) longer than the annulus – LCA distance, and right and non-coronary Valsalva sinuses < 25 mm (figure 1A,B). We implanted a 23 mm self-expanding valve and protected the LCA with a 4.5 mm × 26 mm stent (figure 1C). After implantation and, although the left main coronary artery remained patent, we failed to remove the stent, leaving it trapped between the prosthesis and the calcified aortic wall (figure 1D). A first failed capture attempt was made via radial access through the initial JL 3.5 catheter and a snare. As an alternative, another JL 4 catheter was advanced via contralateral femoral access, and a guide catheter extension system was introduced through the cells of the prosthesis (video 1 of the supplementary data). The snare was advanced distal to the stent, and upon withdrawal, it was captured (video 2 of...