Protected PCI of 58-year-old Woman Demonstrated at TCT 2015 Live Case
The first full day of the TCT conference kicked off on Monday, October 12. There was a lot of buzz around the convention hall, including results from the ABSORB III trial, the DRAGON study, former California Governor Arnold Schwarzenegger, and Protected PCI.
The morning kicked off in the Coronary Theater with a 10 a.m. live case from Dr. David Kandzari from Piedmont Hospital, Atlanta, GA. Dr. Kandzari presented the case of a 58-year-old woman with severe coronary artery disease and pulmonary hypertension to a panel of physicians moderated by Dr. George Dangas.
Dr. Kandzari described the woman as a smoker with hypotension, peripheral disease, and carotid disease. She was referred from another hospital with unstable angina and right-sided heart failure. On admission, her ejection fraction was normal. An echocardiogram revealed pulmonary hypertension and right ventricular systolic pressure of 83. She was considered for coronary artery bypass graft surgery (CABG), but determined to be too high risk because of left main stenosis with calcium around three ventricles, proximal disease in the left anterior descending artery, a totally occluded right coronary artery, and significant vascular disease. She was referred to a complex interventional team and underwent cardiac catheterization. The goal of catheterization was complete revascularization.
While the panel of physicians discussed different treatment options for this patient, Dr.
Kandzari noted hemodynamic support with the Impella was chosen due to her high pulmonary artery systolic pressures. First, the Impella device was placed. The physicians then performed an angioplasty and placed a stent in the iliac artery. Next, the catheter was advanced to the left main and atherectomy was performed..
Atherectomy was discussed among panelists and suggested approaches were rotoblation or balloon angioplasty. Dr. Kandzari explained a method using two speeds—one pass at low speed, and one pass at high speed if the vessel is less than 3 in diameter—to ablate on the way in and way out. He noted this method provided a more effective ablation. The patient responded well hemodynamically.
After treatment of the left main, a provisional stent was placed in the circumflex, and then the right coronary artery was treated. Dr. Dangas remarked the hemodynamic support provided by the Impella allowed the heart team the time it needed to complete the PCI procedure.
Dr. Kandzari showed pictures of the resulting left main and the left anterior descending artery. He explained both the placement as well as the retraction of the Impella. Dr. Kandzari noted the improvements in the procedure available due to hemodynamic support.
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/.