scholarly journals The role of mechanical support devices during percutaneous coronary intervention

2021 ◽  
Vol 10 ◽  
pp. 204800402110140
Author(s):  
Ritesh Kanyal ◽  
Jonathan Byrne
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Cardiogenic Shock ◽  
High Risk Patient ◽  
Haemodynamic Effect ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Percutaneous Coronary ◽  
Artery Disease

The practice of interventional cardiology has changed dramatically over the last four decades since Andreas Gruentzig carried out the first balloon angioplasty. The obvious technological improvements in stent design and interventional techniques have facilitated the routine treatment of a higher risk cohort of patients, including those with complex coronary artery disease and poor left ventricular function, and more often in the setting of cardiogenic shock (CS) complicating acute myocardial infarction (AMI). The use of mechanical cardiac support (MCS) in these settings has been the subject of intense interest, particularly over the past decade . A number of commercially available devices now add to the interventional cardiologist’s armamentarium when faced with the critically unwell or high-risk patient in the cardiac catheter laboratory. The theoretical advantage of such devices in these settings is clear- an increase in cardiac output and hence mean arterial pressure, with variable effects on coronary blood flow. In doing so, they have the potential to prevent the downward cascade of ischaemia and hypoperfusion, but there is a paucity of evidence to support their routine use in any patient subset, even those presenting with cardiogenic shock. This review will discuss the use and haemodynamic effect of MCS devices during percutaneous coronary intervention (PCI), and also examine the clinical evidence for their use in patients with cardiogenic shock, and those undergoing ‘high risk’ PCI

scholarly journals Left brachial artery: one more way to percutaneous insertion of IMPELLA 2.5L circulatory support for high-risk percutaneous coronary intervention – a case report

2020 ◽  
Author(s):  
Paolo Sganzerla ◽  
Francesco Cinelli ◽  
Andrea Capoferri ◽  
Mauro Rondi
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Circulatory System ◽  
Common Femoral Artery ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Artery Disease

Abstract Background Percutaneous circulatory support allows the performance of coronary interventions in ever more complex anatomic and clinical situations. The large-bore systems currently available need a suitable vascular calibre to be inserted restricting percutaneous access mainly to the common femoral artery. Case summary We present the case of a 64-year-old man, admitted with an acute coronary syndrome and congestive heart failure, due to triple-vessel coronary artery disease with left main involvement and left ventricular dysfunction. He was successfully treated with percutaneous coronary intervention (PCI) supported through an IMPELLA 2.5L circulatory system. Concomitant severe and diffuse peripheral vascular disease did not allow femoral insertion of the circulatory support which was therefore successfully introduced through a left brachial percutaneous approach. Discussion To the best of our knowledge, this is the first report of a brachial, percutaneous placement of the IMPELLA 2.5L system to support a high-risk PCI procedure. In appropriately selected patients, this approach could be an option when common vascular accesses are not available.

Outcome of Impella 2.5 use in patients undergoing Percutaneous Coronary Intervention in Henan, China: a case series

Perfusion ◽  
2021 ◽  
pp. 026765912110490
Author(s):  
Rafiq Ahmed Bhat ◽  
Syed Manzoor Ali ◽  
Akanksha Rathi ◽  
Javaid Akhter Bhat ◽  
Raja Saqib Iqbal ◽  
...  
Keyword(s):  
Heart Failure ◽  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Cardiogenic Shock ◽  
Case Series ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Hemodynamic Support ◽  
Percutaneous Coronary ◽  
Case Number

Background: Acute myocardial infarction (AMI) complicated by cardiogenic shock (AMI-CS) or heart failure is associated with an unacceptably high in-hospital mortality of 33%–55% and a lost chance to accept PCI (Percutaneous Coronary Intervention). Aim: The aim of the study was to find out whether percutaneous hemodynamic support device Impella 2.5 improves prognosis of high-risk PCI patients or not. Methods: This study was a case series involving six patients who underwent a Left Ventricular Assist Device (LVAD, Impella 2.5, Abiomed, Danvers, MA) implantation after suffering from AMI with a very low ejection fraction and acute heart failure. The clinical experience and outcomes of the patients are hereby discussed. Results: All PCI procedures were safely completed under LVAD support. The hemodynamic parameters of all patients improved clinically over the next 30 days and following 12 months after Impella insertion except in two patients, of which one patient (Case number 6) died 4 days post-Impella protected PCI procedure due to acute left ventricle heart failure with cardiogenic shock and pulmonary oedema; and another one died at 12 months after Impella protected PCI procedure (Case number 4) due to decompensated heart failure and infected pneumonia. Conclusion: Percutaneous hemodynamic support is favorable and feasible during high risk Percutaneous Coronary Intervention (PCI). A bigger study is needed to substantiate the claims of the current study.

scholarly journals Successful extracorporeal membrane oxygenation assisted revascularisation in a high-risk elderly patient refused surgical treatment

2020 ◽  
Vol 26 (4) ◽  
pp. 205-210
Author(s):  
Robertas Samalavičius ◽  
Lina Puodžiukaitė ◽  
Vytautas Abraitis ◽  
Ieva Norkienė ◽  
Nadežda Ščupakova ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Elderly Patients ◽  
Extracorporeal Membrane Oxygenation ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Uneventful Recovery ◽  
Membrane Oxygenation ◽  
Percutaneous Coronary

Management of high-risk elderly patients requiring revascularisation remains a clinical challenge. We report a case of extracorporeal membrane oxygenation (ECMO) assisted complex percutaneous coronary intervention in a high-risk octogenarian. An 83-yearold female with signs of worsening heart failure was admitted to the emergency department of a tertiary care facility. Transthoracic echocardiography revealed a decreased left ventricular ejection fraction of 20% with severe mitral regurgitation and mild aortic and tricuspid valve insufficiency. Three-vessel disease was found during coronary angiography. Due to the patient’s frailty, a high-risk surgery decision to proceed with ECMO assisted percutaneous coronary intervention was made during a heart team meeting. Following initiation of mechanical support, coronary lesions were treated with three drug-eluting stents. After the procedure, the patient was transferred to the ICU on ECMO support, where she was successfully weaned from the device 9 h later. Her ICU stay was four days. She was successfully discharged from the hospital after uneventful recovery. At one-year’s follow-up, the patient was clinically stable in an overall state of general well-being and with complete participation in routine activities; she had good exercise tolerance and no signs of ischemia. This report highlights the possibility of use of ECMO during PCI in high-risk elderly patients.

scholarly journals The Role of Percutaneous Haemodynamic Support in High-risk Percutaneous Coronary Intervention and Cardiogenic Shock

2015 ◽  
Vol 10 (1) ◽  
pp. 39 ◽  
Author(s):  
Dagmar M Ouweneel ◽  
Bimmer E Claessen ◽  
Krischan D Sjauw ◽  
José PS Henriques ◽  
◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Cardiogenic Shock ◽  
Coronary Intervention ◽  
Assist Devices ◽  
Cardiac Assist ◽  
Cardiac Assist Devices ◽  
Percutaneous Coronary ◽  
Haemodynamic Improvement

The experience and usage of percutaneous cardiac assist devices in cardiogenic shock as well as high-risk percutaneous coronary intervention have increased over the years. Nonetheless, there is still little evidence of clinical benefit of these devices other than immediate haemodynamic improvement. Despite the fact that these devices are used to treat a rather complex patient population, clinical testing remains important in order to evaluate their true impact on clinical outcome before being adopted into clinical practice. Therefore, this review shows an overview of the current experience and evidence of the available percutaneous cardiac assist devices.

scholarly journals Effect of Percutaneous Coronary Intervention on Left Ventricular Diastolic Function in Patients With Coronary Artery Disease

2015 ◽  
Vol 8 (1) ◽  
pp. 270 ◽  
Author(s):  
Nahid Salehi ◽  
Mohammadreza Saidi ◽  
Alireza Rai ◽  
Farid Najafi ◽  
Seedmokhtar Javeedannejad ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Diastolic Function ◽  
Left Ventricular Diastolic Function ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Ventricular Diastolic Function ◽  
Percutaneous Coronary ◽  
Artery Disease

<p><strong>BACKGROUND:<em> </em></strong>There is considerable disagreement over the effects of percutaneous coronary intervention (PCI) on left ventricular diastolic function that has necessitated the investigation of diastolic indices. The present study was conducted to evaluate left ventricular diastolic function and its indices, three months after performing the PCI procedure in patients with coronary artery disease (CAD).</p> <p><strong>METHODS:<em> </em></strong>In a quasi-experimental clinical trial study (before and after), 51 patients with CAD scheduled for elective PCI were investigated provided that their Ejection Fraction (EF) was &gt; 30%. Before and three months after PCI, echocardiography was carried out to evaluate left ventricular diastolic indices including the E/Ea as the most important criteria for diagnosis of diastolic heart failure (DHF).<strong></strong></p> <p><strong>RESULTS:<em> </em></strong>Based on the E/Ea indices and after PCI, the number of patients with DHF decreased significantly: 40 patients (78.4%) before PCI versus 28 patients (54.9%) after PCI (p&lt;0.05). The Mean and Standard error of deceleration time (DT), isovolumic relaxation time (IVRT), early diastolic mitral annulus velocity; Ea (E'), E/Ea and left ventricular ejection function (LVEF) indices underwent significant changes. In addition, MVA dur/PVA dur, PVs/PVd, and E/Ea indices had changed significantly after PCI in both genders. However, no significant difference was reported for the other indices.</p> <p><strong>CONCLUSION:<em> </em></strong>The E/Ea ratio as an important criterion for diagnosis of DHF was improved after PCI. Improvement of several other diastolic indices was observed after the PCI procedure. It can be concluded that PCI can be an effective treatment modality in patients with left ventricular diastolic indices.</p>

Percutaneous Mechanical Circulatory Support Devices Use in Cardiogenic Shock and High-Risk Percutaneous Intervention.

2021 ◽  
Vol 8 (08) ◽  
pp. 5578-5583
Author(s):  
Usman Sarwar ◽  
Nikky Bardia ◽  
Amod Amritphale ◽  
Hassan Tahir ◽  
MD Ghulam M.Awan
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Coronary Intervention ◽  
Percutaneous Intervention ◽  
Circulatory Support ◽  
Percutaneous Coronary ◽  
Mechanical Circulatory Support Devices ◽  
Support Devices

Statistical data has shown that patients now treated in cardiac catheterization laboratories are older with several comorbidities, including renal failure, diabetes, and heart failure [1]. In past patients who were not suitable candidates for percutaneous coronary intervention due to their numerous comorbidities now seems to be a suitable candidate due to tremendous advancements in the field of interventional cardiology like new stent design and availability of advance mechanical circulatory support devices, i.e., Impella performing PCI on these high-risk patients become a viable option. There are two areas of cardiology in which mechanical circulatory support devices keep evolving: one is high-risk (percutaneous coronary intervention) PCI, and the other is a cardiogenic shock that is refractory to initial pressor support.  In this article, we review evidence base data regarding the use of mechanical circulatory support devices in high-risk percutaneous intervention and cardiogenic shock.

scholarly journals Clinical Characteristics and Outcomes From Percutaneous Coronary Intervention of Last Remaining Coronary Artery

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Ahmad Shoaib ◽  
Muhammad Rashid ◽  
Evangelos Kontopantelis ◽  
Andrew Sharp ◽  
Eoin F. Fahy ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
High Risk ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Sensitivity Analyses ◽  
Control Group ◽  
Percutaneous Coronary

Background: Patients with complex high-risk coronary anatomy, such as those with a last remaining patent vessel (LRPV), are increasingly revascularized with percutaneous coronary intervention (PCI) in contemporary practice. There are limited data on the outcomes of these high-risk procedures. Methods: We analyzed a large longitudinal PCI cohort (2007–2014, n=501 841) from the British Cardiovascular Intervention Society database. Clinical, demographic, procedural, and outcome data were analyzed by dividing patients into 2 groups; LRPV group (n=2432) and all other PCI groups (n=506 691). Results: Patients in the LRPV PCI group were older, had more comorbidities, and higher prevalence of moderate-severe left ventricular systolic dysfunction. Mortality was higher in the LRPV PCI group during hospital admission (12 % versus 1.5 %, P <0.001), at 30 days (15% versus 2%, P <0.001), and at one-year (24% versus 5%, P <0.001). In a propensity score matching analysis the adjusted risk of mortality during index admission (odds ratio, 2.05 [95% CI, 1.65–2.44], P <0.001), at 30 days (odds ratio, 2.13 [95% CI, 1.78–2.5], P <0.001), at 1 year (odds ratio, 1.81 [95% CI, 1.59–2.03], P <0.001), and in-hospital major adverse cardiovascular events (odds ratio, 1.8 [95% CI, 1.42–2.19], P <0.001) were higher in LRPV PCI group as compared to control group. In sensitivity analyses, similar clinical outcomes were observed irrespective of which major epicardial coronary artery was treated. Conclusions: In this contemporary cohort, patients who had PCI to their LRPV had a higher-risk profile and more adverse clinical outcomes, irrespective of the vessel treated.

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