Chan K.Y.E.Un K.C.Chiu H.O.A.C.Tai-Leung Chan D.Sze S.Y.Yin W.H.Lee Y.T.Lee Y.T.Lin P.Abdel-Wahab M.Pop A.M.Tchetche D.Freeman P.De Backer O.Poon K.Chandavimol M.Tang G.H.L.Wong C.K.Lam S.C.C.Mahidol University2026-06-202026-06-202026-06-22Jacc Cardiovascular Interventions Vol.19 No.12 (2026) , 1565-157819368798https://repository.li.mahidol.ac.th/handle/123456789/117435The UNICORN (undermining iatrogenic coronary obstruction with radiofrequency needle) technique was developed in 2022 to reduce the risk for coronary obstruction during valve-in-valve transcatheter aortic valve replacement. The procedure involves traversing the target leaflet with an electrified wire, followed by serial dilation with coronary and peripheral balloons. A balloon-expandable valve is then delivered into the de novo fenestration for intraleaflet deployment. As the balloon-expandable valve expands, the target leaflet is opened and displaced away from the at-risk coronary ostium, resulting in a minimal neoskirt on the target side. Since its introduction, the technique has been adopted at numerous centers worldwide, with various modifications and adaptations. In this paper, a step-by-step description of the UNICORN procedure is provided, and troubleshooting strategies for potential challenges are discussed.MedicineReviewSCOPUS10.1016/j.jcin.2026.04.0312-s2.0-10504162595718767605