Severe Aortic Stenosis and Proximal Left Anterior Descending Artery Stenosis: A Positron Emission Tomography/Computed Tomography Assessment Before and After Transcatheter Aortic Valve Implantation

Abstract

We report the case of an 82-year-old patient with symptomatic severe aortic stenosis and calcified proximal left anterior descending (LAD) artery stenosis who underwent a transfemoral transcatheter aortic valve implantation (TAVI) without complex percutaneous coronary intervention. Before TAVI, a positron emission tomography/computed tomography assessment confirmed a reduced global coronary flow reserve (CFR), more pronounced on the LAD territory. One month post-TAVI, a second positron emission tomography/computed tomography scan showed a normalization of the global CFR and more than a doubling in the LAD territory. This case illustrates that mechanisms other than vessel stenosis may play an important role in CFR in the setting of aortic stenosis.