Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Apr 26, 2020; 12(4): 155-160
Published online Apr 26, 2020. doi: 10.4330/wjc.v12.i4.155
Subclavian Impella 5.0 to the rescue in a non-ST elevation myocardial infarction patient requiring unprotected left main rotablation: A case report
Vasileios Panoulas, María Monteagudo-Vela, Konstantinos Kalogeras, Andre Simon
Vasileios Panoulas, Konstantinos Kalogeras, Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London UB9 6JH, United Kingdom
Vasileios Panoulas, Cardiovascular Sciences, National Heart and Lung Institute, Imperial College, London SW7 2BU, United Kingdom
María Monteagudo-Vela, Andre Simon, Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London UB9 6JH, United Kingdom
Author contributions: Panoulas V drafted the manuscript; Panoulas V, Monteagudo-Vela M and Kalogeras K performed the case and collected the images; Simon A reviewed the manuscript and offered clinical advice.
Informed consent statement: Patient has granted us informed consent to publish this case report.
Conflict-of-interest statement: Dr Panoulas in receipt of consultancy fees and honoraria from Abiomed.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Vasileios Panoulas, MD, MRCP, PhD, Honorary Senior Lecturer at Imperial College London, Consultant Cardiologist, Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Hill End Road, Harefield, London UB9 6JH, United Kingdom. v.panoulas@imperial.ac.uk
Received: December 15, 2019
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Impella, Subclavian, Rotablation, Left main, Percutaneous coronary intervention, Case report

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.