Dr. Ajay Kirtane Presents Case Study on 61-year-old CHIP Patient at TCT 2015
On Tuesday evening, October 13, at the session on CHIP or Complex, High-Risk and Indicated PCI, Dr. Ajay Kirtane of Columbia University Medical Center, New York, New York presented a high risk PCI case of a 61 year old with coronary artery bypass graft surgery, graft failure, and left ventricular ejection fraction of 35%.
Angiography showed compete total occlusion of the right coronary artery and about 50% occlusion of the distal left main artery. A positron emission tomography (PET) scan of the right coronary artery showed inferior ischemia. Right heart pressures were normal. Angina symptoms were worsening, despite treatment with 4 medications for angina. This patient had residual CCS 1 -2 angina and was referred for refractory angina.
Dr. Kirtane suggested hemodynamic support during PCI due to the treatment of the left main coronary artery. The case was conducted with intravascular ultrasound guidance. Revascularization of the left main was successful. PCI on the right coronary artery was conducted with retrograde complete total occlusion and reverse controlled antegrade and retrograde tracking (CART) approach. Complete revascularization was achieved in the right coronary artery. Post-procedure, the patient reported complete cessation of angina and was discharged from the heart failure clinic.
Dr. Kirtane noted that revascularization has an effect on the quality of life of patients. Many people could improve their quality of life as Dr. Kirtane remarked, “of 67,640 patients with new heart failure each year, only 27.9% had coronary disease assessment to 90 days.”
The Impella 2.5 system is a temporary (<6 hours) ventricular support device indicated for use during high risk percutaneous coronary interventions (PCI) performed in elective or urgent, hemodynamically stable patients with severe coronary artery disease and depressed left ventricular ejection fraction, when a heart team, including a cardiac surgeon, has determined high risk PCI is the appropriate therapeutic option. Use of the Impella 2.5 in these patients may prevent hemodynamic instability which can result from repeat episodes of reversible myocardial ischemia that occur during planned temporary coronary occlusions and may reduce peri- and post-procedural adverse events.
Protected PCI and use of the Impella 2.5 is not right for every patient. Patients may not be able to be treated with Impella if they have certain pre-existing conditions, which a cardiologist can determine, such as: severe narrowing of the heart valve, severe peripheral artery disease, clots in blood vessels, or a replacement heart valve or certain heart valve deficiencies. Additionally, use of Impella has been associated with risks, including, but not limited to valvular and vascular injury, bleeding, and limb ischemia in certain patients. Learn more about the Impella devices’ approved indications for use, as well as important safety and risk information at www.protectedpci.com/indications-use-safety-information/