Published online Apr 26, 2020. doi: 10.4330/wjc.v12.i4.155
Peer-review started: December 15, 2019
First decision: January 15, 2020
Revised: March 24, 2020
Accepted: March 28, 2020
Article in press: March 28, 2020
Published online: April 26, 2020
Often in patients with significant three-vessel or left main disease there is coexistent significant peripheral disease rendering them poor candidates for percutaneous left ventricular support during revascularization. Evidence on the management of such cases is limited.
We describe a case of such a patient with critical distal left main disease and chronically occluded right coronary artery who presented with chest pain and a non-ST elevation myocardial infarction and had significantly impaired left ventricular function. With the aid of our cardiothoracic surgeons a cut down subclavian Impella 5.0 was inserted and high risk rotablation percutaneous coronary intervention carried out successfully.
This case highlights the need for cross-specialty collaborations in such high-risk cases were alternative access is needed for insertion of large bore mechanical circulatory support devices.
Core tip: This case highlights the importance of the coming together of the cardiothoracic surgeons and interventional cardiologists in treating patients in caridogenic shock with high risk coronary anatomy features. In this particular case the Impella 5.0 was implanted using a surgical cut down through the subclavian access and supported extreme high risk unprotected left main rotablation percutaneous coronary intervention. The patient made an excellent recovery with remarkable left ventricular function improvement in one-year follow-up.