{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:50:28Z","timestamp":1753876228542,"version":"3.41.2"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2023,7,8]],"date-time":"2023-07-08T00:00:00Z","timestamp":1688774400000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Severe aortic stenosis (AS) and coronary artery disease (CAD) often coexist since they both share the same risk factors and pathophysiology. Patients with severe AS with prohibitive surgical risk are often treated with transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) as a staged or concurrent procedure. Significant calcified CAD and left ventricular (LV) systolic impairment in such patients would add more challenges to the management. A clear consensus on the timing of revascularization of such patients in relation to the TAVI procedure is lacking.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>Herein, we present an 86-year-old male who presented to a local district hospital with non-ST-segment elevation myocardial infarction (N-STEMI) and decompensated heart failure. His transthoracic echocardiography showed moderate LV systolic impairment with low-flow severe AS. He was initially treated with dual anti-platelet and diuretic therapy and subsequently underwent coronary angiography that revealed severe calcified shelf-like left main stem (LMS) and moderate left anterior descending (LAD) disease. He was successfully treated with TAVI and rotational atherectomy (RA)-assisted PCI to LMS and LAD in the same setting.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>There is limited evidence on effective strategies to tackle high-risk angioplasty with concurrent TAVI in patients with impaired LV function. We performed TAVI and RA to LMS and LAD in the same setting using no mechanical circulatory support (MCS). Management strategies should be individualized to highly selected patients taking into account LMS involvement, calcium modulation strategies, haemodynamic instability, or cardiogenic shock and whether MCS is needed.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytad301","type":"journal-article","created":{"date-parts":[[2023,7,8]],"date-time":"2023-07-08T13:28:27Z","timestamp":1688822907000},"source":"Crossref","is-referenced-by-count":0,"title":["Rotational atherectomy of left main stem immediately after transcatheter aortic valve implantation in a patient with symptomatic severe aortic stenosis and an impaired left ventricular systolic function: a case report"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0703-7805","authenticated-orcid":false,"given":"Zahir","family":"Satti","sequence":"first","affiliation":[{"name":"Cardiothoracic Department, Freeman Hospital, Newcastle University , Freeman Rd, Newcastle upon Tyne, NE7 7DN , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0811-7679","authenticated-orcid":false,"given":"Mohamed","family":"Farag","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, Freeman Hospital, Newcastle University , Freeman Rd, Newcastle upon Tyne, NE7 7DN , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3642-318X","authenticated-orcid":false,"given":"Mohaned","family":"Egred","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, Freeman Hospital, Newcastle University , Freeman Rd, Newcastle upon Tyne, NE7 7DN , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3088-8878","authenticated-orcid":false,"given":"Mohammad","family":"Alkhalil","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, Freeman Hospital, Newcastle University , Freeman Rd, Newcastle upon Tyne, NE7 7DN , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,7,8]]},"reference":[{"key":"2023072013282996100_ytad301-B1","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1056\/NEJMoa1700456","article-title":"Surgical or transcatheter aortic-valve replacement in intermediate-risk patients","volume":"376","author":"Reardon","year":"2017","journal-title":"N Engl J Med"},{"key":"2023072013282996100_ytad301-B2","doi-asserted-by":"crossref","first-page":"2069","DOI":"10.1093\/eurheartj\/ehu247","article-title":"Aortic stenosis and coronary artery disease: what do we know? 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A comprehensive review of the literature with proposed treatment algorithms","volume":"35","author":"Paradis","year":"2014","journal-title":"Eur Heart J"},{"key":"2023072013282996100_ytad301-B3","first-page":"553","article-title":"Revascularization in the transcatheter aortic valve replacement population","volume":"10","author":"Alkhalil","year":"2021","journal-title":"Interv Cardiol Clin"},{"key":"2023072013282996100_ytad301-B4","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1136\/heart.84.3.347","article-title":"Interface between valve disease and ischaemic heart disease","volume":"84","author":"Iung","year":"2000","journal-title":"Heart"},{"key":"2023072013282996100_ytad301-B5","doi-asserted-by":"crossref","first-page":"24","DOI":"10.17925\/HI.2020.14.1.24","article-title":"Management of coronary artery disease in the setting of transcatheter aortic valve replacement","volume":"14","author":"Katta","year":"2020","journal-title":"Heart Int"},{"key":"2023072013282996100_ytad301-B6","doi-asserted-by":"crossref","first-page":"1703","DOI":"10.1016\/j.jacc.2014.01.017","article-title":"Coronary artery calcification","volume":"63","author":"Madhavan","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"2023072013282996100_ytad301-B7","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/j.jacc.2015.10.103","article-title":"Outcomes in patients with transcatheter aortic valve replacement and left main stenting: the TAVR-LM registry","volume":"67","author":"Chakravarty","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2023072013282996100_ytad301-B8","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.amjcard.2011.09.053","article-title":"Comparison of outcomes in patients having isolated transcatheter aortic valve implantation versus combined with preprocedural percutaneous coronary intervention","volume":"109","author":"Abdel-Wahab","year":"2012","journal-title":"Am J Cardiol"},{"key":"2023072013282996100_ytad301-B9","doi-asserted-by":"crossref","first-page":"2371","DOI":"10.1016\/j.jcin.2016.09.024","article-title":"The rationale for performance of coronary angiography and stenting before transcatheter aortic valve replacement: from the interventional section leadership council of the American College of Cardiology","volume":"9","author":"Ramee","year":"2016","journal-title":"JACC Cardiovasc Interv"},{"key":"2023072013282996100_ytad301-B10","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1002\/ccd.27339","article-title":"Orbital and rotational atherectomy during percutaneous coronary intervention for coronary artery calcification","volume":"92","author":"Lee","year":"2018","journal-title":"Catheter Cardiovasc Interv"},{"key":"2023072013282996100_ytad301-B11","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1016\/j.jcin.2021.06.041","article-title":"ACTIVATION (Percutaneous Coronary inTervention prIor to transcatheter aortic VAlve implantaTION): a randomized clinical trial","volume":"14","author":"Patterson","year":"2021","journal-title":"JACC Cardiovasc Interv"},{"key":"2023072013282996100_ytad301-B12","doi-asserted-by":"crossref","first-page":"e8919","DOI":"10.1097\/MD.0000000000008919","article-title":"The safety of concomitant transcatheter aortic valve replacement and percutaneous coronary intervention: a systematic review and meta-analysis","volume":"96","author":"Yang","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"2023072013282996100_ytad301-B13","doi-asserted-by":"crossref","first-page":"71","DOI":"10.31083\/j.rcm2302071","article-title":"Mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock","volume":"23","author":"Al-Atta","year":"2022","journal-title":"Rev Cardiovasc Med"},{"key":"2023072013282996100_ytad301-B14","doi-asserted-by":"crossref","first-page":"33","DOI":"10.31083\/j.rcm2301033","article-title":"Coronary revascularization in patients with left ventricle systolic dysfunction, current challenges and clinical outcomes","volume":"23","author":"Abdalwahab","year":"2022","journal-title":"Rev Cardiovasc Med"}],"container-title":["European Heart Journal - 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