Key result
Prolonged transaxillary Impella 5.0 support is linked to thrombosis and embolic stroke upon device removal.
Case Report (n=1)
No
Prolonged right transaxillary Impella 5.0 support, particularly with concurrent sepsis, carries a risk of innominate artery thrombosis, highlighting the potential utility of pre-removal CT angiography.
Alerts to thrombosis risk with prolonged transaxillary Impella in sepsis; leaves open pre-removal imaging protocols.
We describe an unexpected complication in a 46-years-old man affected by ischemic cardiomyopathy who received a prolonged mechanical cardiac support by means of right transaxillary Impella 5.0. The postoperative course was complicated by recurrent septicemia from multi-durg resistant Acinetobacter baumanii. He underwent implantation of venoarterial extracorporeal membrane oxygenation because of refractory cardiac arrest, followed by Impella removal that has been complicated by embolic stroke. The likely source of the embolus was a large thrombus inside the innominate artery. After a long-standing right transaxillary device implantation, particularly in patients with intercurrent septic episodes, a CT angiographic scan should be planned to exclude arterial thrombosis before removal of the transarterial device.
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Cannata et al. (2021) conducted a case report in Ischemic cardiomyopathy and cardiogenic shock (n=1). Right transaxillary Impella 5.0 was evaluated on Complications during/after device removal. Prolonged mechanical cardiac support with a right transaxillary Impella 5.0, particularly in the setting of recurrent sepsis, was complicated by innominate artery thrombosis and massive embolic stroke upon device removal.
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