Key result
Protected PCI using Impella support was successfully performed in a patient with a stenotic Cabrol type SVG graft, restoring pulsatility and normal mean arterial pressure.
Why the study?
Percutaneous left ventricular assist devices may minimize hemodynamic compromise during high-risk PCI and allow complete revascularization, but a good understanding of cardiac hemodynamics is essential in these cases.
Case Report (n=1)
No
A comprehensive understanding of circulatory support physiology and hemodynamics is crucial for troubleshooting loss of pulsatility during high-risk protected PCI with Impella.
Answers are grounded in this paper and cite their sources.
May support Impella feasibility in rare Cabrol SVG stenoses; hypothesis-generating and requires prospective validation before broader adoption.
The use of percutaneous left ventricular assist devices (VAD) may minimize the risk of hemodynamic compromise during such high-risk percutaneous coronary intervention (PCI) and allow complete revascularization, thus improving outcomes. A good understanding of cardiac hemodynamics is essential in making informed decisions during such cases. A 61-year-old male with an extensive surgical cardiac history including a modified Cabrol type anastomosis with saphenous vein (SVG) conduits to two coronary arteries presented to our hospital with severe substernal chest discomfort and was noted to have diffuse ST depressions along with subtle ST elevations in lead aVR suggestive of diffuse sub-endocardial ischemia. Diagnostic coronary angiography revealed significant stenosis in the Cabrol type SVG grafts and we opted for a protected PCI using Impella (Abiomed, Danvers, MA) support. A significant drop in the blood pressure was noted and despite trouble-shooting, the Impella arterial line tracing remained minimally pulsatile. A comprehensive understanding of circulatory support physiology was ultimately crucial in making an informed decision for a successful PCI outcome.
No takes yet. Share an insight, caveat, or question.
Siddiqui et al. (2020) conducted a case report in NSTEMI with significant stenosis in Cabrol type SVG grafts (n=1). Protected PCI using Impella CP support was evaluated on Successful PCI and hemodynamic stability. Protected PCI using Impella support was successfully performed in a patient with a stenotic Cabrol type SVG graft, restoring pulsatility and normal mean arterial pressure.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: