Transcatheter aortic valve implantation (TAVI) plays a 
crucial role in the management of severe Aortic stenosis 
(AS) regardless of the surgical risk. The burden of 
coronary artery disease (CAD) in these patients is 
considerable as CAD and severe AS increase with 
population aging. In the past, Treatment of severe AS 
associated with CAD was treated with coronary artery 
bypass graft (CABG) with surgical aortic valve 
replacement but nowadays we have another alternative 
which is TAVI and PCI in those patients. Nowadays, 
there is an expansion in the indications of TAVI to lowrisk and younger patients so coronary complications can 
occur later in their life so there will be an increase in the 
need for coronary management after TAVI and there will 
be some challenges, especially with tall frame 
transcatheter heart valves (THV). we aimed in our 
review to discuss the different strategies to protect or to 
treat the CAD in patients' candidates for TAVI either 
before or after the procedure and also, we aimed to 
discuss the tips and tricks for coronary re-access after 
TAVI