Guide Extension-Assisted Stent Implantation at Ostial Right Coronary Artery Creating Stent Tunnel During Transcatheter Aortic Valve Replacement

Coronary artery occlusion is an uncommon but life-threatening complication of transcatheter aortic valve replacement (TAVR). Both low coronary artery height and externally mounted stented bioprosthesis present an increased risk for coronary artery occlusion, and various prevention strategies have been recommended. We present an 86-year-old woman with failed surgical bioprosthesis, concomitant obstructive ostial right coronary artery (RCA) lesion, and low coronary ostial heights who underwent simultaneous TAVR and percutaneous coronary intervention of ostial RCA. Due to suprannular valve expansion after post-dilation, the RCA ostium was compromised, and a novel stent tunnel was created under the native leaflets towards the left coronary sinus to maintain RCA perfusion.