Removal of Impella in the Setting of Left Ventricular Thrombus: A Potential Indication for Cerebral Embolic Protection Devices

Successful percutaneous mechanical circulatory support (MCS) has been used for acute stabilization of cardiogenic shock (CS). Improved survival outcomes have been observed in patients with CS from an acute myocardial infarction (AMI) who undergo implantation of left ventricular (LV) to ascending aorta rotodynamic pumps, such as the Impella® device (Abiomed). However, thrombotic events are a known complication of such devices in poor flow states such as CS. There is limited evidence regarding the management of patients who develop an LV thrombus after Impella insertion. Currently, the Sentinel cerebral protection system (SCPS, Boston Scientific) is the only FDA-approved device for cerebral embolic protection during transcatheter aortic valve replacement procedures. While the use of a cerebral embolic protection device (CEPD) has a theoretical benefit, no current CEPD is approved for use in conjunction with Impella device removal or other MCS devices. We present a case describing the use of the SCPS during the removal of the Impella CP device in a patient who developed an LV thrombus after CS from AMI. Our case highlights a potential role for the expanded use of CEPDs in similar clinical scenarios.