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Page 8 of 11 Raval et al. Vessel Plus 2024;8:5 https://dx.doi.org/10.20517/2574-1209.2023.99

Figure 1. Approach to diagnostic evaluation and management of CAD in patients undergoing TAVI. CAD-coronary artery disease,
TAVI-transcatheter aortic valve implantation, AS-aortic stenosis, PCI-percutaneous coronary intervention, ACS-acute coronary
syndrome, NSTEMI-non-ST elevation myocardial infarction, CTA-computed tomography angiography, ICA-invasive coronary
angiography, LM-left main artery, LAD-left anterior descending artery.

access in patients with complex anatomy, especially with valve-in-valve TAVI . We use the algorithm, as
[52]
shown in Figure 1, to guide decision-making regarding the evaluation and management of CAD in patients
undergoing TAVI.

In summary, the question remains whether patients with stable obstructive CAD either benefit from PCI
pre- or post-TAVI or even benefit from PCI compared with guideline-directed medical therapy. There are
two randomized trials investigating the role of PCI in TAVI-treated patients in stable CAD. The primary
objective of the TAVI PCI Trial (ClinicalTrials.gov: NCT04310046) is to compare iFR-guided complete
revascularization performed within 45 days pre-TAVI or within 45 days post-TAVI in patients treated with
the Edwards Sapien Transcatheter heart valve who have severe aortic stenosis and concomitant CAD. The
COMPLETE TAVR Trial (ClinicalTrials.gov: NCT04634240) will determine whether a strategy of complete
revascularization of all suitable lesions with staged PCI post-TAVI with the Edwards Sapien valve is
superior to a strategy of medical therapy alone for CAD in reducing the composite outcome of
cardiovascular death, new MI, ischemia driven revascularization, or hospitalization for unstable angina or
heart failure.

CONCLUSION
Concomitant CAD and AS are frequently seen in clinical practice. Evaluation and management of CAD in
patients with severe AS undergoing TAVI continues to remain an area needing further research. In