Management of asymptomatic coronary artery disease in patients candidates for transcatheter aortic valve implantation

Coronary artery disease (CAD) and severe aortic stenosis (AS) often coexist. When significant coronary lesions were found in patients undergoing surgical aortic valve replacement, combined coronary artery bypass grafting was the gold standard of treatment. Differently, the management of concomitant CAD in patients who are candidates for transcatheter aortic valve implantation (TAVI) is a matter of debate. In this review, we discuss the evidence and present the current viewpoints regarding the definition and prognostic implications of CAD in patients undergoing TAVI and the potential role and limitations of invasive functional coronary stenosis assessment in severe AS. We present the challenges of percutaneous coronary intervention (PCI) in this setting, including timing of intervention, completeness of revascularization in the context of the complexity of the disease and the risk associated with the PCI procedure itself. Finally, we mention ongoing trials that should provide some long-awaited answers in this field.