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Raval et al. Vessel Plus 2024;8:5 https://dx.doi.org/10.20517/2574-1209.2023.99 Page 9 of 11

choosing to treat CAD with severe AS, the institutional structure and availability of close follow-up must be
taken into consideration. ICA is the gold standard for CAD evaluation pre-TAVI; however, it is not always
necessary. In younger patients with a low pre-test probability of CAD, coronary CTA provides a useful
alternative. In older patients, the gated non-coronary CTA used for TAVI evaluation alone may be
sufficient to exclude CAD in the left main or proximal vessels. When ICA is indicated, the use of FFR and
iFR is recommended for indeterminant stenotic CAD, but the interpretation of the results needs caution.
After ICA, if the need for PCI is identified, it is reasonable to pursue PCI pre-TAVI to avoid issues with
future coronary access, but may lead to increased bleeding complications with TAVI. If post-TAVI PCI is
planned, the selection of a transcatheter heart valve should be made with the preservation of coronary
access in mind. Ultimately, a personalized approach depending on the anatomy and clinical profile is
needed. Adequately powered randomized controlled studies are needed to determine whether significant
stable CAD needs PCI in TAVI patients and to assess the optimal timing for PCI.

DECLARATIONS
Author’s contribution
Conceptualization, methodology, investigation, resources, writing original draft, writing - review and
editing, visualization, project administration: Raval M, Gordon PC
Software: Raval M
Supervision: Gordon PC

Availability of data and materials
This is a review article and all data mentioned in the article can be obtained from the appropriate citation.

Financial support and sponsorship
None.

Conflicts of interest
Maharshi Raval has no conflicts of interest to disclose; Paul C. Gordon receives research grant support from
Edwards Lifesciences.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2024.

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