Abstract
BACKGROUND
Complex and high-risk coronary intervention (CHIP-PCI) and PCI in cardiogenic shock complicating acute coronary syndrome is increasingly performed under mechanical circulatory support—so called protected PCI. Among the available options, Impella CP heart pump (ABIOMED) is percutaneously inserted over the femoral artery and typically requires a second arterial access to perform PCI, which further enhances the risk of vascular and bleeding complications. The single-access technique allows Impella CP placement and PCI performance through the same vascular access. When a 7-french system is desirable, only a long and entirely hydrophilic coated sheath has been previously used, which is not available in Europe.
CASE SUMMARY
A 85-year-old patient admitted with NSTE-ACS, severely reduced left ventricular function and three-vessel coronary artery disease underwent single access CHIP-PCI under Impella CP support. After a failed attempt to insert a standard 7-french long femoral sheath alongside the Impella catheter, we successfully introduced a 7.5-french sheathless guiding catheter and delivered the planned percutaneous treatment with the benefits conferred by a 7-french—rather than 6 - lumen catheter, without the need for an additional arterial access.
DISCUSSION
This is, to the best of our knowledge, the first case of CHIP-PCI performed under Impella support utilizing the single-access technique with a 7.5-french sheathless guiding catheter. Beyond advantages of the single-access technique in sparing time and avoiding vascular complications associated with gaining a second arterial access, the lower outer diameter of the sheathless catheter compared with standard 7-french sheaths may allow improved limb perfusion and lower chance of interference with the impella CP catheter.
SAFETY AND EFFICACY OF SINGLE ACCESS IMPELLA FOR HIGH-RISK PERCUTANEOUS INTERVENTION (SHIP) COMPARED TO STANDARD APPROACH
