Coronary obstruction (CO) is a rare but life-threatening complication of transcatheter aortic valve implantation (TAVI), particularly in valve-in-valve (ViV-TAVI) and redo-TAVI procedures. This chapter provides a comprehensive overview of the incidence, mechanisms and predictors of CO, emphasising the importance of detailed pre-procedural imaging and procedural planning. Multimodal assessments—particularly computed tomography—are essential to identify at-risk anatomies and guide strategies to prevent CO. Techniques such as chimney stenting and leaflet modification (e.g. BASILICA) are discussed in depth, with procedural steps and supporting outcome data. Special attention is given to the evolving challenges of coronary protection in redo-TAVI, where anatomical complexities and valve designs may affect procedural success. As TAVI expands to younger populations, the ability to prevent and manage CO becomes increasingly critical. Emerging technologies, including computational modelling and dedicated leaflet-splitting tools, are poised to improve safety in this high-risk cohort.