Redo transcatheter aortic valve implantation (TAVI) in patients with prior transapical SAPIEN 3 valves carries a significant risk of coronary obstruction (CO). Chimney stenting is an established strategy to maintain coronary perfusion in high-risk valve-in-valve (ViV) procedures. We treated an 87-year-old cachectic woman with BMI of 16.9 kg/m² who presented with cardiac decompensation due to severe restenosis of a 20 mm SAPIEN 3 valve implanted using a transapical approach in 2017. Computed tomography revealed index prosthesis frame extension beyond the sinotubular junction at the right coronary sinus, posing a risk of RCA occlusion. A staged transfemoral redo-TAVI using a 23 mm Medtronic Evolut FX+ valve was performed followed by deployment of the pre-positioned stent in the so-called chimney technique. The RCA guidewire and undeployed coronary stent were positioned in advance as a protective measure before valve deployment. During valve deployment, inferior ST-segment elevation occurred, prompting stent implantation in order to restore RCA patency. Angiography confirmed preserved coronary flow and optimal valve function. Careful preprocedural evaluation—including CT-based assessment of coronary height, sinus anatomy, and virtual valve modeling—is essential to minimize the risk of CO in ViV or redo-TAVI procedures. The chimney technique provides an effective bailout strategy for acute coronary obstruction, while procedural strategies such as commissural alignment and the cusp-overlap technique can optimize procedural and hemodynamic outcomes. Pre-emptive coronary protection using chimney stenting enables safe and effective redo transfemoral TAVI in patients with complex anatomy and prior transapical valve implantation, ensuring hemodynamic success and minimizing complications.

Background: Catheter-based renal denervation (RDN) is an interventional therapy for patients with resistant or uncontrolled arterial hypertension after the exclusion of secondary causes. This study aimed to evaluate the effects of the SPYRAL™ catheter system on systolic (SBP) and diastolic blood pressure (DBP) in a real-world clinical setting. Additionally, we explored whether the number of ablation points was associated with the magnitude of blood pressure (BP) reduction. Methods: We conducted a retrospective, single-center study including patients aged ≥18 years with predominantly resistant hypertension with preserved renal function (eGFR ≥40 mL/min/1.73 m2) and no evidence of secondary hypertension. Ambulatory blood pressure monitoring (ABPM) and renal function were assessed at baseline and three months after RDN. Patients were stratified into subgroups based on the number of ablation points (≤20 vs. >20). A two-tailed p -value <0.05 was considered statistically significant. Results: Data from eleven patients (mean age 64.4 ± 8.1, 45.5% were male) were analyzed. At three months, eGFR remained stable (mean decrease −4.6 mL/min/1.73 m ² , CI 95% −15.8–6.6, p = 0.37). Mean ambulatory SBP and DBP decreased significantly following RDN ( Δ −19.4mmHg, CI 95% −9.2 to −29.7, p = 0.002; Δ −8.6 mmHg, CI 95% −3.9 to −13.3, p = 0.002; for SBP and DBP respectively). Subgroup analysis revealed that patients with more ablation points experienced a greater reduction in SBP ( Δ −17.7 mmHg, CI 95% 0.1–35.3, p = 0.04) and a numerically greater reduction in DBP ( Δ −4.8 mmHg, CI 95% 4.5–12, p = 0.27) than those with fewer abation points. Conclusion: In this small retrospective cohort, reductions in SBP and DBP were observed following RDN using the SPYRAL™ multi-electrode system, with no excess of adverse renal events. These preliminary findings require confirmation in larger, adequately powered patient cohorts before firm conclusions can be established.