Vol 30, No 6 (2023)
Image in Cardiovascular Medicine
Published online: 2023-09-29

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Sky is the limit for Impella-assisted percutaneous coronary intervention: Four technologies, three vessels, two bifurcations and one chronic total occlusion

Aleksandra Gąsecka1, Norbert Czyżak1, Marcin Lampart1, Arkadiusz Pietrasik1
Pubmed: 38287669
Cardiol J 2023;30(6):1053-1054.

Abstract

Not available

interventionAL CARDIOLOGY

IMAGE IN CARDIOVASCULAR MEDICINE

Cardiology Journal

2023, Vol. 30, No. 6, 1053–1054

DOI: 10.5603/cj.96740

Copyright © 2023 Via Medica

ISSN 1897–5593

eISSN 1898–018X

Sky is the limit for Impella-assisted percutaneous coronary intervention: Four technologies, three vessels, two bifurcations and one chronic total occlusion

Aleksandra GąseckaNorbert CzyżakMarcin LampartArkadiusz Pietrasik
1st Chair and Department of Cardiology, Medical University of Warsaw, Poland

Address for correspondence: Dr. Arkadiusz Pietrasik, 1st Chair and Department of Cardiology, Medical University of Warsaw, ul. Banacha 1a, 02–097 Warszawa, Poland, tel: +48 22 599 19 51, fax: +48 22 599 19 57, e-mail: arekpietrasik@icloud.com

Received: 3.08.2023 Accepted: 27.08.2023

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

A 73-year-old woman after percutaneous coronary intervention (PCI) of the left main (LM), left anterior descending (LAD) artery and diagonal branch with implantation of 5 drug-eluting stents (2020) was admitted due to heart failure exacerbation. Echocardiography showed left ventricular ejection fraction (LVEF) of 13%, severe secondary mitral regurgitation (MR) and moderate tricuspid regurgitation (TR). Coronary angiography demonstrated multivessel disease (SYNTAX score 47.5; Fig. 1A, B) with in-stent restenosis of the LM and LAD and chronic total occlusion of the circumflex (Cx). Considering the high risk of mortality (EuroSCORE II 22.1%), the Heart Team opted for PCI supported with percutaneous ventricular assist device. An Impella CP pump was inserted via the right femoral artery (Fig. 1C). Fielder XTR wire supported by the SuperCross 90 microcatheter was used for Cx antegrade penetration. Following multiple predilatations, intravascular lithotripsy was performed in the LM, proximal LAD and proximal Cx (3.0 × 12 mm, 3.5 × 12 mm balloons). LAD segments were further treated using drug--eluting balloons (3.5 × 20 mm, 3.0 × 30 mm). Next, everolimus-eluting stent (3.5 × 15 mm) was implanted into the ostium and proximal Cx using T-stenting and the protrusion technique, followed by kissing balloon inflation in the LAD and Cx (4.0 × 12 mm, 3.5 × 12 mm, respectively) and the proximal optimization technique (5.0 × 8 mm). Intravascular ultrasound confirmed proper expansion and apposition of the stents (Fig. 1D, E). Impella was removed 2 days after the procedure. Echocardiography at 3 months showed LVEF of 23%, moderate MR and mild TR. The use of Impella provided hemodynamic stability, enabl- ing the successful performance of extremely high-risk PCI.

Figure 1. Coronary angiography demonstrating a 90% stenosis in the distal segment of the right coronary artery (A), in-stent restenosis of the left main (LM) artery and left anterior descending (LAD) artery and chronic total occlusion (CTO) of the circumflex artery with proximal bending of close to 90 degrees and calcifications (B). Impella CP pump was inserted through a 14 F peel-away sheath via right femoral artery and 7 F EBU 3.75 catheter was introduced through the Impella sheath (C). Good final result of the percutaneous coronary intervention of in-stent restenosis of the LM and LAD and CTO of the circumflex artery using T-stenting and protrusion technique confirmed in intravascular ultrasound (D) and angiography (E).
Conflict of interest: None declared