The RASE Technique for Extraction of a Protruding Aorto-Ostial Coronary Stent

BACKGROUND: Significant protrusion of an aorto-ostial coronary stent into the aortic root may complicate transcatheter aortic valve replacement (TAVR) by increasing the risk of valve-stent interaction, TAVR balloon rupture, or stent deformation. Safe management strategies remain poorly defined. CASE SUMMARY: An 84-year-old man undergoing pre-TAVR evaluation was found to have ostial right coronary artery disease; this was treated with percutaneous coronary intervention, resulting in 7-mm stent protrusion into the aorta, precluding safe TAVR. After heart team evaluation, the patient underwent intentional stent fracture, reverse hairpin-assisted guidewire re-entry, and controlled snare-assisted extraction of the protruding stent (termed the RASE technique [reverse hairpin-assisted avulsion and stent extraction]). Successful staged TAVR was later performed. DISCUSSION: This case describes a novel guidewire-controlled technique for safe extraction of a protruding aorto-ostial stent, enabling definitive transcatheter valve therapy. TAKE-HOME MESSAGES: Aorto-ostial stent protrusion may preclude safe TAVR and requires multimodality assessment and heart team planning. The RASE technique may facilitate safe and controlled extraction of the protruding stent segment.