Novel technique of performing multivessel PCI through an Impella sheath

Kris Kumar, Sridhar Reddy, Deepak Acharya, Kapildeo Lotun

Research output: Contribution to journalArticle

Abstract

A 69-year-old woman with diabetes was found to have multi-vessel coronary artery disease and underwent 5-vessel coronary artery bypass grafting. Patient had persistent cardiogenic shock postoperatively despite intra-aortic balloon pump and escalating pressor requirements. Electrocardiogram showed new ischemic changes and the patient was urgently taken to the catheterization lab for coronary angiography and placement of an Impella CP for higher degree of hemodynamic support via the left femoral artery. Due to limitations in vascular access the Impella CP sheath was utilized for vascular access for diagnostic angiography and coronary intervention concurrently with ongoing Impella CP support. The first obtuse marginal had severe proximal disease and was treated with percutaneous coronary intervention (PCI) with a drug eluting stent. To our knowledge, this case is the first in which successful diagnostic angiography as well as multi-vessel PCI was performed via an Impella sheath while concurrently using the percutaneous mechanical circulatory support system of the Impella CP. Multiple guide catheters and a pigtail catheter were successfully passed via the Impella CP sheath to perform PCI. This novel method of vascular access could be an important tool to use in high-risk patients with limitations in access sites and decrease potential bleeding complications by limiting the number of arterial punctures.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - Jan 1 2019

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Percutaneous Coronary Intervention
Blood Vessels
Coronary Angiography
Catheters
Drug-Eluting Stents
Cardiogenic Shock
Femoral Artery
Cardiovascular System
Punctures
Coronary Artery Bypass
Catheterization
Coronary Artery Disease
Angiography
Electrocardiography
Hemodynamics
Hemorrhage

Keywords

  • CS—shock, cardiogenic
  • MCS—mechanical circulatory support ECMO/IABP/Tandem/Impella
  • PCI—percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Novel technique of performing multivessel PCI through an Impella sheath. / Kumar, Kris; Reddy, Sridhar; Acharya, Deepak; Lotun, Kapildeo.

In: Catheterization and Cardiovascular Interventions, 01.01.2019.

Research output: Contribution to journalArticle

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