ABC | Volume 113, Nº6, December 2019

Case Report Arq Bras Cardiol. 2019; 113(6):1151-1154 Choudhury et al. Emergent rotational post-TAVI Figure 1 – Percutaneous coronary intervention to circumflex artery lesion. A) Emergent coronary angiogram showing the new ostial left circumflex filling defect and prior mid‑circumflex lesion. Inset view shows ostial left circumflex lesion at greater magnification. B) Rotablator 1.5 mm burr entering culprit ostial left circumflex artery lesion. C) Ostial left circumflex lesion after rotational atherectomy shows angiographic improvement. D) Final angiographic result after stent insertion and high-pressure post-dilatation. into the ostium, as in our case (Figures 2-4). Modification of coronary lesions may require RA to debulk calcific deposits permitting passage of stents and adequate expansion. The rate of major RA-related complications (in-hospital death, cardiac tamponade, and emergent surgery) was 1.3% according to a Japanese registry, increased with age and was approximately 4 times higher if RA was performed in an emergency setting of coronary artery disease per se. 5 Previous use of RA in TAVI patients have been in an elective setting unlike our report. RA in a TAVI setting poses additional challenges, particularly with suboptimal guide engagement. Conclusion This case highlights the complexity of coronary obstruction following TAVI and the need for availability of alternate arterial access (i.e. radial) and various modalities of revascularization (i.e. RA). Importantly, it highlights the necessity of a heart team approach with the seamless and unencumbered transition from a surgical domain (transapical TAVI) to the interventional realm (PCI with RA). Pre-procedural CT guided planning in terms of prosthesis selection, implantation technique, and bailout strategy in case of coronary compromise is also of critical importance. Author contributions Conception and design of the research and Critical revision of the manuscript for intellectual content: Choudhury T, Bakar S, Kiaii B, Teefy P; Acquisition of data, Analysis and interpretation of the data and Writing of the manuscript: Choudhury T, Bakar S. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. 1152