Impella-Supported Optical Coherence Tomography-Guided Aggressive Rotational Atherectomy for Heavily Calcified Lesions in Left Main Trunk Bifurcation in a Patient with Severe Left Ventricular Systolic Dysfunction.
Masahiro KoideKento FukuiHikaru SugimotoYuki TakedaKoji SogabeYukinori KatoHiroki KitajimaSatoshi AkabamePublished in: Case reports in cardiology (2023)
The Impella, a percutaneous left ventricular assist device, has been reported to minimize the risk of hemodynamic compromise and improve clinical outcomes during percutaneous coronary intervention (PCI) in complex high-risk indicated patients (CHIPs). Optical coherence tomography (OCT) provides information on calcified plaque thickness, which is helpful in determining the indication and endpoint of atherectomy during PCI for calcified lesions. However, there are few reports on OCT-guided aggressive rotational atherectomy with Impella assistance in CHIPs. A 71-year-old man on dialysis for end-stage renal failure was admitted for congestive heart failure. Transthoracic echocardiography revealed severe left ventricular systolic dysfunction, and coronary angiography performed after improvement of heart failure showed severe stenosis with heavily calcified lesions in the left main trunk (LMT) bifurcation and right coronary artery. The patient refused coronary artery bypass surgery and was revascularized using PCI. PCI was started with prophylactic Impella CP insertion because of the high risk of hemodynamic collapse. After OCT-guided rotational atherectomy with 1.5- and 2.0-mm burr toward the left anterior descending artery and left circumflex artery, respectively, double-kissing culotte stenting was performed in the LMT, and good dilation was obtained. Impella CP was removed immediately after PCI without hemodynamic compromise, and the procedure was completed.
Keyphrases
- percutaneous coronary intervention
- left ventricular
- left ventricular assist device
- optical coherence tomography
- coronary artery bypass
- heart failure
- acute myocardial infarction
- antiplatelet therapy
- st segment elevation myocardial infarction
- coronary artery disease
- acute coronary syndrome
- st elevation myocardial infarction
- cardiac resynchronization therapy
- coronary artery bypass grafting
- diabetic retinopathy
- end stage renal disease
- hypertrophic cardiomyopathy
- atrial fibrillation
- coronary artery
- extracorporeal membrane oxygenation
- chronic kidney disease
- left atrial
- aortic stenosis
- minimally invasive
- early onset
- mitral valve
- optic nerve
- case report
- peritoneal dialysis
- oxidative stress
- ejection fraction
- lower limb
- newly diagnosed
- blood pressure
- drug induced
- healthcare
- single cell
- acute heart failure
- pulmonary artery
- social media