How to address the coronaries in TAVI candidates: can the need for revascularization be safely determined by CT angiography only?

European heart journal. Imaging methods and practice Pub Date : 2024-10-28 eCollection Date: 2024-04-01 DOI:10.1093/ehjimp/qyae096
Katharina Theresa Julia Mascherbauer, Gudrun Lamm, Andreas Anselm Kammerlander, Maximilian Will, Christian Nitsche, Roya Anahita Mousavi, Caglayan Demirel, Philipp Emanuel Bartko, Konstantin Schwarz, Christian Hengstenberg, Julia Mascherbauer
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Abstract

Coronary artery disease (CAD) remains one of the most frequent comorbidities among transcatheter aortic valve implantation (TAVI) candidates. Whether routine assessment of CAD by invasive coronary angiography (CA) and eventual peri-procedural percutaneous coronary intervention (PCI) is generally beneficial in TAVI patients has recently been heavily questioned. CA carries significant risks, such as kidney injury, bleeding, and prolonged hospital stay, and may frequently be unnecessary if significant stenoses of the proximal coronary segments can be ruled out on computed tomography angiography. Moreover, the benefits of pre-emptive coronary revascularization at the time of TAVI are not well defined. Despite these facts and weak guideline recommendations, CA and eventual PCI of stable significant coronary lesions at the time of TAVI remain common practice. However, ongoing randomized trials currently challenge the efficacy of such strategies to enable a more streamlined, individualized, and resource-sparing treatment with TAVI.

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如何处理 TAVI 候选者的冠状动脉:仅通过 CT 血管造影能否安全地确定是否需要进行血管再通术?
冠状动脉疾病(CAD)仍然是经导管主动脉瓣植入术(TAVI)患者最常见的合并症之一。通过有创冠状动脉造影术(CA)对冠状动脉疾病进行常规评估并最终进行围手术期经皮冠状动脉介入治疗(PCI)是否对经导管主动脉瓣植入术(TAVI)患者有普遍益处,近来备受质疑。冠状动脉造影有很大的风险,如肾损伤、出血和住院时间延长,而且如果通过计算机断层扫描血管造影可以排除冠状动脉近端明显狭窄,那么冠状动脉造影往往是不必要的。此外,在进行 TAVI 时预先进行冠状动脉血运重建的益处尚未明确。尽管存在这些事实,且指南建议不充分,但在进行 TAVI 时对稳定的重要冠状动脉病变进行 CA 和最终 PCI 仍是常见的做法。然而,目前正在进行的随机试验对这些策略的疗效提出了质疑,这些策略可使 TAVI 治疗更加简化、个体化和节省资源。
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