Novel percutaneous intervention technique for obstructed coronary artery after valve‐in‐valve transcatheter aortic valve replacement

Abstract Valve‐in‐valve transcatheter aortic valve replacement (valve‐in‐valve TAVR) increases the risk of coronary obstruction. Although the coronary protection strategy is widely used, the use of the bailout technique after coronary obstruction is limited. Hence, we report a simple bailout technique for coronary obstruction after valve‐in‐valve TAVR. An 82‐year‐old woman presented with structural valve deterioration. The left anterior descending coronary artery had 90% stenosis. After TAVR, the prosthetic valve shifted close to the ascending aorta wall, consequently impairing coronary flow. The wire crossed with the Judkins right guiding catheter (JR) reference to the en‐face and perpendicular views. Using the guide‐extension catheter, the JR contacted the contralateral ascending aorta as a backup catheter. After a balloon was dilated between the prosthetic valve and aorta, JR engaged into the coronary artery with excellent backup. This novel “Whisker pole guiding technique” is useful, even after valve‐in‐valve TAVR.