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ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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vol. 16
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Mechanical circulatory support during high-risk percutaneous coronary intervention in a young male patient

Artur Pawlik
Paweł Kleczyński
Dariusz Dudek
Artur Dziewierz
2, 3
Stanisław Bartuś
2, 3

Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
Adv Interv Cardiol 2020; 16, 3 (61): 347–348
Online publish date: 2020/10/02
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A 58-year-old man, with a history of myocardial infarction, hypercholesterolemia, smoking, arterial hypertension, chronic obstructive pulmonary disease, paroxysmal atrial fibrillation, and stroke, was transferred from another hospital to our department to undergo high-risk percutaneous coronary intervention (PCI). Previously performed coronary angiography revealed a multi-vessel disease with significant stenosis of the left main (LM) and left ascending coronary artery (LAD), as well as occlusions of the right coronary artery and circumflex artery (Figure 1 A). Due to severely depressed left ventricular (LV) function (ejection fraction of 25%) and the need for complex PCI of the last remaining vessel, after the discussion with the heart team, he was scheduled for PCI with the support of a percutaneous left ventricular assist device (pLVAD) – so-called ‘protected PCI’ [1].
After the initial peripheral angiography confirming eligibility for using pLVAD, a 14 Fr sheath was inserted into the right femoral artery. The Impella CP system (Abiomed Inc., Danvers MA, USA) was delivered to the LV and started providing a cardiac output of 3.4 l/min. Subsequently, intravascular ultrasound (IVUS) guided PCI using the right transradial approach was started. During each balloon inflation, the curve of blood pressure measured in the ascending aorta was flattened (Figure 1 B), which meant that cardiac output was provided only by pLVAD. Eventually, a 3.5 × 48 mm drug-eluting stent was successfully implanted in the LM/LAD (Figures 1 C, D). The femoral artery was closed with the Perclose ProGlide closure system (Abbott Cardiovascular, Santa Clara, CA, USA). Further hospitalization was uncomplicated, and after 3 days, the patient was discharged home.
The Impella CP provides up to 4 l/min cardiac output covering 70–100% of the heart contractile function [2]. Therefore, the arterial pressure drops during the described procedure did not manifest themselves either as severe cardiac arrhythmias or cardiac arrest. The operator was able to continue the intervention, prepare highly calcified and complex lesions, and apply advanced percutaneous techniques, resulting in good stent apposition. As the introduction of Impella CP is relatively easy and safe, we assume that this device should be used more often in carefully selected patients, especially since the national healthcare system in Poland reimburses its use during high-risk PCIs [3]. The heart team consultation should help in choosing patients who will benefit from this technology the most.

Conflict of interest

The authors declare no conflict of interest.
1. Al-Rashid F, Hildebrandt HA, Kahlert P. Protected percutaneous coronary intervention – a new road for success in treating complex patients. Adv Interv Cardiol 2016; 1245: 200-2.
2. Shishehbor MH, Moazami N, Tong MZ, et al. Cardiogenic shock: from ECMO to Impella and beyond. Cleve Clin J Med 2017; 84: 287-95.
3. Dudek D, Rakowski T, Sukiennik A, et al. Circulatory support with Impella CP device during high-risk percutaneous coronary interventions: initial experience in Poland. Adv Interv Cardiol 2016; 12: 254-7.
Copyright: © 2020 Termedia Sp. z o. o. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
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