#TAVI and #PCI in severe Aortic Regurgitation. 59 year old female patient, radiation induced valve disease with predominant severe AR. Leaflets fibrotic, minimal calcium stuck in a semi-open postition. Porcelain Aorta, functional #CTO of severely calcified RCA. AR2 guide with contra from LCA. Mamba catheter and Fighter wire easy to pass. One DES back to the ostium of the RCA. #Sentinel placement for cerebral protection via the right radial. Carefull implantation of an oversized #Accurate Neo valve (size M to a small anuulus) under fast pacing 150 bpm. Excellent angiographic and hemodynamic result and discharge on day 3. Femoral closure with #Manta 18F. Ilias Ninios Athinodoros Nikitopoulos Asimaki Maria Athens Medical Grοup APOSTOLOS PAPPAS #interventionapcardiology #TAVR