CASE REPORT   

Minerva Cardioangiologica 2019 August;67(4):348-55

DOI: 10.23736/S0026-4725.18.04647-9

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Left ventricular support during complex transradial percutaneous coronary intervention for complete revascularization

Annamaria DACHILLE ¹, Amelia FOCACCIO ¹, Lucio SELVETELLA ², Giovanni NAPOLITANO ³, Carlo BRIGUORI ¹✉

¹ Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy; ² Department of Vascular Surgery, Clinica Mediterranea, Naples, Italy; ³ Department of Cardiology, San Giuliano Hospital, Giugliano, Naples, Italy

Although there is not uniform definition of high-risk percutaneous coronary intervention (PCI), patients with severe three-vessel disease, left main disease, single remaining patent vessel and/or depressed left ventricular ejection fraction are considered a high-risk population. In this setting, periprocedural hemodynamic instability represents a serious issue. Percutaneous mechanical circulatory support (MCS) devices may improve both safety and efficacy of high-risk PCI. Indeed, MCS help to maintain coronary perfusion pressure and reduce myocardial workload, providing the operator sufficient time to reach the target of complete revascularization. The most used MCS are intra-aortic balloon pump and Impella. There are a plenty of data in literature about the efficacy and safety of the use of MCS in high-risk PCI performed through the femoral access. However, there is a paucity of data about the use of MCS in transradial high-risk PCI. Radial over femoral access has been showed to reduce bleeding complications and therefore may further improve the outcome of high-risk PCI. Herein we report a case of transradial high-risk PCI supported by the Impella 2.5 L and review the available data on this topic.

KEY WORDS: Heart-assist devices; Percutaneous coronary intervention; Radial artery; Intra-aortic balloon pumping