High-Risk PCI and a Decision-Making Algorithm

February 9, 2018

Dr. Punag Divanji of University of California, San Francisco presents a case of a 93 year old man with CAD, COPD, and atrial fibrillation who presented with sudden onset, severe chest and abdominal pain. Prior to this event, he was active and independent. His echocardiogram was 45% with a normal right ventricle and a severe mitral regurgitation. The diagnostic angiogram showed severe in-stent restenosis of the right coronary artery and severe left main bifurcation disease. The LVEDP was elevated at 21. The patient was turned down for CABG due to his Syntax score and with the multidisciplinary heart team approach and the use of a high-risk PCI algorithm, Dr. Divanji made the decision to proceed with a Protected PCI with Impella support. His intervention plan included:

  • Impella CP placement via femoral access
  • Treatment of the RCA, vessel preparation with rotational atherectomy
  • Treatment of the Left Circumflex
  • Treatment of the Left Main bifurcation

The Impella was explanted and the patient was discharged home on post-cath lab day 3 without complication.

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