Why the study?
Despite routine use of Impella for percutaneous mechanical circulatory support, vascular and bleeding complications may occur during large-bore access removal, requiring appropriate treatment strategies to ensure patient recovery and survival.
This review provides strategies for managing large-bore access complications and patient deterioration during protected high-risk PCI with Impella.
Careful post-hoc selection of vascular closure techniques remains critical after Impella removal; leaves open optimal large-bore access strategies.
Despite the routine use of percutaneous mechanical circulatory support (pMCS) with the Impella heart pump, vascular and bleeding complications may occur during removal with or without pre-closure. To safely close the large-bore access (LBA), post-hoc selection of the appropriate treatment of vascular complications is critical to patient recovery and survival. Femoral artery access is typically utilized for LBA, and percutaneous axillary artery access is a common alternative, especially in the instance of severe peripheral artery disease. Optimization of patient outcomes and efficiency of pMCS can be achieved with adequate arterial access using state-of-the-art techniques. Impella removal techniques with or without pre-closure will be addressed as well as the management of large-bore femoral access complications. In addition, treatment strategies to manage patient deterioration during a protected high-risk percutaneous coronary intervention will be provided.
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Sinning et al. (2022) studied this question.
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