OCT-Derived FFR-Guided Management of Iatrogenic RCA Deformation During Transcatheter Tricuspid Annuloplasty

Background Iatrogenic right coronary artery (RCA) deformation is a rare but potentially life-threatening complication of transcatheter tricuspid annuloplasty (TTA) with K-Clip. Although bailout coronary stenting may restore vessel patency, unnecessary stent implantation exposes patients to long-term risks.Case summary A 77-year-old woman with symptomatic severe tricuspid regurgitation underwent TTA with K-Clip. Angiography demonstrated RCA deformation; optical coherence tomography (OCT) revealed extrinsic mechanical deformation without intraluminal injury, and OCT-derived fractional flow reserve (FFR) demonstrated the absence of physiologically significant flow limitation; hence, percutaneous coronary intervention was deferred.Discussion Angiography may overestimate the severity of RCA deformation following TTA with K-Clip. This case demonstrates the potential of OCT-derived FFR to optimize procedural decision-making and improve the safety of TTA. Further prospective studies are needed to validate this strategy and establish its role in routine clinical practice.Take-home message OCT-derived FFR adds objective physiological assessment and avoids unnecessary coronary stenting during TTA and may represent a novel imaging-guided algorithm to improve procedural safety.